Abstract 2759: Effect of Telmisartan and Ramipril on Atrial Fibrillation Episodes Recurrence and Severity in Hypertensive Patients With Metabolic Syndrome and Lone Paroxysmal Atrial Fibrillation
To evaluate the effect of telmisartan (T) and ramipril (R) on atrial fibrillation (AF) recurrence and severity, on P-wave dispersion (PWD) and on atrial collagen type I syntesis and catabolism (evaluated respectively by procollagen type I carboxy terminal peptide [PIP] and by carboxy-terminal telopeptide [CTT]). Three hundred and seventy four mild hypertensive (SBP >140 <160 mmHg and/or DBP >90 <100 mmHg) outpatients in sinous rhythm but with at least 2 ECG-documented episodes of AF in the previous 6 months were randomized to T 80 to 160 mg/od (n=125) or to R 5 to 10 mg/od (n=124) or to amlodipine (A) 5 to 10 mg/od (n=125) for one year. Clinic blood pressure (BP) and a 24 h ECG were evaluated monthly. Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible and to undergo a venous blood drawing to evaluate plasma cardiac troponin-I (cTn-I). PWD and serum PIP and CTT were evaluated before and at the end of each treatment period. SBP and DBP were significantly and similarly reduced by the 3 treatments (p<0.001). A total of 56 (44.6%) patients treated with A had a recurrence of AF as did 32 (25.8%) patients treated with R (p<0.01 vs A) and 19 (15.2%) patients treated with T (p<0.01 vs A, p<0.05 vs R). At the first episode of AF the ventricular rate was 129.8±32.4 b/min with A, 111.5±29.4 b/min with R (p<0.05 vs A) and 107.4±27.9 b/min with T (p<0.05 vs A) and plasma concentration of cTn-I was 0.099±0.029 ng/ml with A, 0.052±0.016 ng/ml with R (p<0.05 vs A) and 0.027±0.09 ng/ml with T (p<0.01 vs A, p<0.05 vs R). PWD values were significantly reduced by R (−4.8 ms, p<0.05) and even more by T (−11.9 ms, p<0.01) the difference being significant (p<0.01). Serum PIP levels were reduced by R (−47.3 μg, p<0.001) and T (−52.4 μg, p<0.001), while serum CTT was increased by R (+0.18 μg, p<0.001) and T (+0.21 μg, p<0.001); they did not change with A. Despite similar BP lowering T and R were more effective than A in preventing new episodes of AF and in reducing their severity as documented by the slower ventricular rate and by the less increase in plasma cTn-I; however, the effect of T was greater than that of R. This could be related with the greater PWD reduction observed with T.