Abstract 3695: Valsartan Amlodipine Combination and Prevention of Atrial Fibrillation Recurrence in Hypertensive Diabetic Patients
To evaluate the effect of antihypertensive treatment with valsartan-amlodipine combination as compared to atenolol-amlodipine combination in preventing the recurrence of atrial fibrillation in hypertensive patients with a history of recent atrial fibrillation. We studied 250 mild hypertensive ( SBP > 130 mmHg < 160 mmHg and/or DBP > 80 < 100 mmHg) out patients with well controlled type 2 diabetes ( HbA1c < 7 %). They were in sinus rhythm but with at least two ECG documented episodes of atrial fibrillation in the previous 6 months. After one week placebo period, they were randomized to valsartan 160 mg plus amlodipine 2.5 mg or to atenolol 100 mg plus amlodipine 2.5 mg in 1:1 ratio with an amlodipine dose titration after 4 (5 mg.), 8 (7.5 mg), and 12 weeks (10 mg) weeks, and were followed for 1 year. Blood pressure was evaluated and a 24 hours ECG was recorded every month; the patients were asked to report any episode of symptomatic atrial fibrillation and to perform an ECG as early as possible. Two hundred and twenty one patients completed the study, 112 in valsartan-amlodipine group and 109 in atenolol-amlodipine group. After 12 months of treatment the blood pressure mean values were significantly reduced both in valsartan-amlodipine group (from 154/96 to 126/76 mmHg, p< 0,001) and in atenolol-amlodipine group (from 155/95 to 128/78 mmHg, p<0,001) without any difference between the two treatments. At least one symptomatic or non symptomatic ECG documented episode of atrial fibrillation was reported in 14 % of the patients treated with valsartan-amlodipine and in 41 % of the patients treated with atenolol-amlodipine (p<0,01). The valsartan-amlodipine combination seems to be more effective than atenolol-amlodipine in preventing new episodes of atrial fibrillation in hypertensive diabetic patients with recurrent atrial fibrillation. These data suggest that angiotensin II type 1 receptor blockade could be able to favourably impact the atrial electrical and structural remodelling in this type of patients.