Abstract 2862: Effect Of Valsartan And Ramipril On P Wave Dispersion And Prevention Of Atrial Fibrillation Recurrence In Hypertensive Patients With Lone Paroxysmal Atrial Fibrillation
Purpose: to compare the effect of valsartan and ramipril on P wave dispersion (PWD) and on prevention of atrial fibrillation (AF) recurrence in hypertensive patients with recent paroxysmal AF.
Methods: Two hundred and twenty eight mild hypertensive ( SBP> 140 < 160 mmHg and/or DBP > 90 > 100 mmHg) out patients in sinous rhythm but with at least 2 ECG-documented episodes of AF in the previous 6 months were randomised to valsartan ( n = 76) or to ramipril ( n = 76) or to amlodipine ( n = 76) and were followed up for 1 year. Clinic BP and ECG were evaluated every month; the patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible.
Results: SBP/DBP values were significantly reduced by the 3 treatments(p < 0,001 both for SBP and DBP) withouth any difference among them. The PWD did not change with amlodipine while it was reduced both by ramipril (from 41 ± 5 to 37 ± 6 ms p < 0,05) and by valsartan (from 40 ± 5 ms to 31 ± 6 ms p < 0,001) but the reduction was significantly greater with valsartan than with ramipril (p < 0,01). At least one ECG documented episode of AF was reported in 30 (40%) patients treated with amlodipine, in 19 (25%) patients treated with ramipril and in 12 (16%) patients treated with valsartan. The Kaplan Mejer analysis showed a significant reduction of AF episodes in valsartan group (p = 0,004 log rank test) as well as in ramipril group (p = 0,043) even if at a lesser degree.
Conclusions: Valsartan and ramipril significantly, reduced PWD while amlodipine did not change it despite the same BP lowering. Both ramipril and valsartan were more effective than amlodipine in preventing new episodes of AF but the effect of valsartan seems to be greater than that of ramipril. It could be related to the greater PWD reduction observed with valsartan than with ramipril.