Abstract 2521: A Multicentre Randomized Study comparing Efficacy Of Telmisartan versus Carvedilol In Preventing Atrial Fibrillation Recurrence In Hypertensive Patients.
Background: The possibility of addressing blood pressure(BP) control and lower incidence of atrial fibrillation(AF) should be a suitable pharmacological goal in antihypertensive therapy. The renin-angiotensin-aldosterone system (RAAS) play an important role as a mediator of atrial remodeling in AF
AIM: this prospective , randomized, multicentre study sought to assess the effect of an antihypertensive treatment with Telmisartan (Telm) and Carvedilol (Carv) in preventing the recurrence of AF in hypertensive pts with a history of recent atrial fibrillation.
Methods and Results: We studied 154 mild hypertensive (SBP>130<160 mmHg and\or DBP>80<100 mmHg) out patients. All pts were in sinus rhytm but with at least from one to four Ecg documented episodes of AF in the previous six months. The two groups didn’t differ dealing with left ventricular(LV) mass, LV Ejection fraction and left atrial diameter. After one week placebo period, they were randomized to telmisartan 80mg once day(od) or to Carv 25 mg od and followed for one year period. BP and 24 hour EKG was monthly recorded. Every pt was asked to report any episode of symptomatic AF and to perform an Ekg as early as possible . 132 pts completed the study ,70 in Telm group and 62 in Carv group.After 12 months the BP mean values were significantly reduced in both group without any difference between the two group. (Telm : 154\97 to 123\75 mmHg P<0.001; Carv Group: 153\94 to 125\78 , p<0,001) Left atrial diameter as assessed by echocardiography was lower in Telm group but didn’t differ statistically significant with Carv Group (Telm: 3,4±2,3 cm ; Carv: 3,6 ±2,4 cm). In 10\70(14,2 %) pts in the Telm group and in 23±62(37,09%) pts in Carv group an episode (symptomatic or asymptomatic )was reported (P<0,005, χ2 test).
Conclusion: Telm seems to be more effective than Carv in preventing new episodes of AF in hyp with recurrent AF . Our results suggest that the angiotensin II receptor blockers (ARBs), also target the RAAS by binding to angiotensin type 1 (AT1) receptors could be favourably interfere the electrical and structural atrial remodeling in hyp pts suggesting an own effect on this phenomen.