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Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease studies.
J Hypertens. 2012 May; 30(5):1004-14.JH

Abstract

BACKGROUND

Evidence on new-onset atrial fibrillation in high-risk vascular patients without heart failure is limited. New-onset atrial fibrillation was a prespecified secondary objective of the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) studies.

METHODS

We studied 30 424 ONTARGET/TRANSCEND patients (mean age ± SD, 66.4 ± 7.0) with vascular disease or complicated diabetes who were in sinus rhythm at entry. A copy of ECG was sent to central office every time new atrial fibrillation was detected by investigators.

RESULTS

During a median follow-up period of 4.7 years, new atrial fibrillation occurred in 2092 patients (15.1 per 1000 patient-years). Risk of atrial fibrillation increased with age, SBP and pulse pressure, left ventricular hypertrophy, BMI, serum creatinine and history of hypertension, coronary artery disease and cerebrovascular disease (all P < 0.01). After adjustment for BMI and other variables, atrial fibrillation risk increased with hip circumference. History of hypertension was associated with a 34% higher risk of new atrial fibrillation. New atrial fibrillation portended an increased risk of congestive heart failure [hazard ratio 2.89, 95% confidence interval (CI) 2.45-3.40, P < 0.01] and cardiovascular death (hazard ratio 1.22, 95% CI 1.05-1.41, P < 0.01). Risk of stroke was unaffected (hazard ratio 1.14, 95% CI 0.93-1.40), whereas that of myocardial infarction was reduced (hazard ratio 0.64, 95% CI 0.50-0.82). Patients with new atrial fibrillation were more likely to receive vitamin K antagonists (P < 0.01), statins (P < 0.05) and β-blockers (P < 0.01) than those in sinus rhythm.

CONCLUSION

New atrial fibrillation is common in high-risk vascular patients and is associated with several risk factors including history of hypertension. Hip circumference was the strongest anthropometric predictor. Despite extensive use of modern therapies, new atrial fibrillation carries a high risk of congestive heart failure and death over a relatively short term.

Authors+Show Affiliations

Department of Medicine, Hospital of Assisi, Assisi, Italy. verdec@tin.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22495138

Citation

Verdecchia, Paolo, et al. "Blood Pressure and Other Determinants of New-onset Atrial Fibrillation in Patients at High Cardiovascular Risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant Subjects With Cardiovascular Disease Studies." Journal of Hypertension, vol. 30, no. 5, 2012, pp. 1004-14.
Verdecchia P, Dagenais G, Healey J, et al. Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease studies. J Hypertens. 2012;30(5):1004-14.
Verdecchia, P., Dagenais, G., Healey, J., Gao, P., Dans, A. L., Chazova, I., Binbrek, A. S., Iacobellis, G., Ferreira, R., Holwerda, N., Karatzas, N., Keltai, M., Mancia, G., Sleight, P., Teo, K., & Yusuf, S. (2012). Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease studies. Journal of Hypertension, 30(5), 1004-14. https://doi.org/10.1097/HJH.0b013e3283522a51
Verdecchia P, et al. Blood Pressure and Other Determinants of New-onset Atrial Fibrillation in Patients at High Cardiovascular Risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant Subjects With Cardiovascular Disease Studies. J Hypertens. 2012;30(5):1004-14. PubMed PMID: 22495138.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood pressure and other determinants of new-onset atrial fibrillation in patients at high cardiovascular risk in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease studies. AU - Verdecchia,Paolo, AU - Dagenais,Gilles, AU - Healey,Jeff, AU - Gao,Peggy, AU - Dans,Antonio L, AU - Chazova,Irina, AU - Binbrek,Azan S, AU - Iacobellis,Gianluca, AU - Ferreira,Rafael, AU - Holwerda,Nicolaas, AU - Karatzas,Nicholas, AU - Keltai,Matyas, AU - Mancia,Giuseppe, AU - Sleight,Peter, AU - Teo,Koon, AU - Yusuf,Salim, AU - ,, PY - 2012/4/13/entrez PY - 2012/4/13/pubmed PY - 2012/8/14/medline SP - 1004 EP - 14 JF - Journal of hypertension JO - J Hypertens VL - 30 IS - 5 N2 - BACKGROUND: Evidence on new-onset atrial fibrillation in high-risk vascular patients without heart failure is limited. New-onset atrial fibrillation was a prespecified secondary objective of the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) studies. METHODS: We studied 30 424 ONTARGET/TRANSCEND patients (mean age ± SD, 66.4 ± 7.0) with vascular disease or complicated diabetes who were in sinus rhythm at entry. A copy of ECG was sent to central office every time new atrial fibrillation was detected by investigators. RESULTS: During a median follow-up period of 4.7 years, new atrial fibrillation occurred in 2092 patients (15.1 per 1000 patient-years). Risk of atrial fibrillation increased with age, SBP and pulse pressure, left ventricular hypertrophy, BMI, serum creatinine and history of hypertension, coronary artery disease and cerebrovascular disease (all P < 0.01). After adjustment for BMI and other variables, atrial fibrillation risk increased with hip circumference. History of hypertension was associated with a 34% higher risk of new atrial fibrillation. New atrial fibrillation portended an increased risk of congestive heart failure [hazard ratio 2.89, 95% confidence interval (CI) 2.45-3.40, P < 0.01] and cardiovascular death (hazard ratio 1.22, 95% CI 1.05-1.41, P < 0.01). Risk of stroke was unaffected (hazard ratio 1.14, 95% CI 0.93-1.40), whereas that of myocardial infarction was reduced (hazard ratio 0.64, 95% CI 0.50-0.82). Patients with new atrial fibrillation were more likely to receive vitamin K antagonists (P < 0.01), statins (P < 0.05) and β-blockers (P < 0.01) than those in sinus rhythm. CONCLUSION: New atrial fibrillation is common in high-risk vascular patients and is associated with several risk factors including history of hypertension. Hip circumference was the strongest anthropometric predictor. Despite extensive use of modern therapies, new atrial fibrillation carries a high risk of congestive heart failure and death over a relatively short term. SN - 1473-5598 UR - https://www.unboundmedicine.com/medline/citation/22495138/Blood_pressure_and_other_determinants_of_new_onset_atrial_fibrillation_in_patients_at_high_cardiovascular_risk_in_the_Ongoing_Telmisartan_Alone_and_in_Combination_With_Ramipril_Global_Endpoint_Trial/Telmisartan_Randomized_AssessmeNt_Study_in_ACE_iNtolerant_subjects_with_cardiovascular_Disease_studies_ L2 - https://doi.org/10.1097/HJH.0b013e3283522a51 DB - PRIME DP - Unbound Medicine ER -