lisinopril and Atrial-Fibrillation

ALLHAT, a randomized, double-blind, active-controlled, multicenter clinical trial of high risk hypertensive participants, compared treatment with an ACE-inhibitor (lisinopril) or calcium channel blocker (amlodipine) with a diuretic (chlorthalidone). Primary outcome was the occurrence of fatal coronary heart disease or nonfatal myocardial infarction. For this report, post-hoc analyses were conducted to determine the contribution of baseline characteristics of participants with or without baseline or incident atrial fibrillation (AF) and atrial flutter (AFL) to stroke, heart failure (HF), coronary heart disease (CHD), and mortality outcomes.. Minnesota Coding of baseline and biennial in-trial ECGs was used to determine the 334 baseline and 537 incident AF/AFL cases, respectively participants with AF/AFL: Cox regression was used to estimate hazard ratios of presence versus absence of either baseline or incident AF/AFL (as time-dependent covariate) for occurrence of stroke, CHD, HF, or mortality, while adjusting for selected baseline characteristics. Adjusted Cox regression was used to obtain hazard ratios (HRs) for presence versus absence of selected baseline characteristics among those with and without either baseline or incident AF/AFL. After adjusting for baseline characteristics, baseline AF/AFL was associated with stroke, HF, and mortality (HRs [95% CIs] 3.18, [2.34-4.33]; 2.65 [2.02-3.49]; and 2.10 [CI, 1.73-2.55], respectively, P < 0.05). Incident AF/AFL was a significant risk factor for HF and mortality (HRs 2.80 and 2.06, respectively, P < 0.05). Risk factor profiles for clinical outcomes for those with and without baseline or incident AF/AFL were largely similar.. AF/AFL is a significant risk factor for stroke, HF, and mortality. Additional risk factors for these outcomes were generally similar for participants with and without baseline or incident AF/AFL.

Topics: Aged; Aged, 80 and over; Amlodipine; Antihypertensive Agents; Atrial Fibrillation; Atrial Flutter; Chlorthalidone; Coronary Disease; Double-Blind Method; Female; Heart Failure; Humans; Hypertension; Lisinopril; Male; Myocardial Infarction; Proportional Hazards Models; Risk Factors; Stroke

Although atrial fibrillation (AF) guidelines indicate that pharmacological blockade of the renin-angiotensin system may be considered for primary AF prevention in hypertensive patients, previous studies have yielded conflicting results. We sought to determine whether randomization to lisinopril reduces incident AF or atrial flutter (AFL) compared with chlorthalidone in a large clinical trial cohort with extended post-trial surveillance.. Compared with chlorthalidone, treatment with lisinopril is not associated with a meaningful reduction in incident AF or AFL among older adults with a history of hypertension.. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

Topics: Amlodipine; Antihypertensive Agents; Atrial Fibrillation; Atrial Flutter; Chlorthalidone; Double-Blind Method; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Incidence; Lisinopril; Male; Middle Aged; Myocardial Infarction; Primary Prevention; Risk Factors; Time Factors; Treatment Outcome; United States

To investigate markers that predict modes of death in patients with chronic heart failure.. Randomised, double blind, three period, comparative, parallel group study (ATLAS, assessment of treatment with lisinopril and survival).. 3164 patients with mild, moderate, or severe chronic heart failure (New York Heart Association functional class II-IV).. High dose (32.5 or 35 mg) or low dose (2.5 or 5 mg) lisinopril once daily for a median of 46 months.. All cause mortality, cardiovascular mortality, sudden death, and chronic heart failure death related to prognostic factors using competing risks analysis. Mode of death was classified by trialists and by an independent end point committee.. Age, male sex, pre-existing ischaemic heart disease, increasing heart rate, creatinine concentration, and certain drugs taken at randomisation were markers of increased risk of all cause mortality and cardiovascular death. There were risk markers for sudden death that were different from the risk markers for death from chronic heart failure. Low systolic blood pressure at baseline, raised creatinine, reduced serum sodium or haemoglobin, and increased heart rate were associated with chronic heart failure death. Use of beta blockers or antiarrhythmic agents (mainly amiodarone) was associated with a reduced risk of sudden death, whereas long acting nitrates and previous use of angiotensin converting enzyme inhibitors were markers for increased risk.. The use of competing risks analysis on the data from the ATLAS study has identified variables associated with certain modes of death in heart failure patients. This approach to analysing outcomes may make it possible to predict which patients might benefit most from particular therapeutic interventions.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Atrial Fibrillation; Cause of Death; Creatinine; Death, Sudden, Cardiac; Double-Blind Method; Female; Heart Failure; Humans; Lisinopril; Male; Middle Aged; Myocardial Ischemia; Risk Assessment; Risk Factors; Stroke Volume; Treatment Outcome

Although atrial fibrillation is common in patients with heart failure, patients with atrial fibrillation are often excluded from congestive heart failure trials or are not analyzed separately. Consequently, while the effect of angiotensin-converting enzyme inhibitors in patients with sinus rhythm is well established, the effect on patients with atrial fibrillation is unknown. The authors hypothesized that these agents might be particularly effective in this patient category, given their antiadrenergic properties and the importance of adequate rate control. Therefore, the effects of lisinopril 10 mg once daily were evaluated in 30 patients with congestive heart failure and chronic atrial fibrillation (mean age, 68 +/- 6 years) in a double-blind, randomized, placebo-controlled trial. All patients were in New York Heart Association class II or III and were stable on conventional therapy (digoxin, diuretics, nitrates). After 6 weeks, mean peak oxygen consumption increased from 14.7 +/- 3.4 to 15.9 +/- 2.9 mL/min/kg in the lisinopril group (P = .034). Plasma norepinephrine levels during exercise and at peak exercise tended to be lower when the patients were taking lisinopril (10.8 +/- 4.2 to 8.9 +/- 4.4 nmol/L and 16.3 +/- 9.2 to 14.3 +/- 7.7 nmol/L, P < .1). Heart rate during exercise and ambulatory monitoring was not significantly affected. Left ventricular fractional shortening tended to increase after lisinopril (23 +/- 7 to 27 +/- 9%, P = .073). Left atrial volume was unchanged, as were plasma atrial natriuretic peptide levels. After subsequent electrical cardioversion, treatment was continued for 6 more weeks, allowing assessment of the effect of lisinopril on maintenance of sinus rhythm; maintenance of sinus rhythm was 71% in the lisinopril group and 36% in the placebo group (P = NS). This study shows that treatment with an angiotensin- converting enzyme inhibitor improves peak oxygen consumption in patients with congestive heart failure and chronic atrial fibrillation. Attenuation of adrenergic drive during exercise may play a role in mediating this effect.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Atrial Fibrillation; Chronic Disease; Double-Blind Method; Drug Administration Schedule; Electric Countershock; Exercise Test; Female; Heart Failure; Humans; Lisinopril; Male; Middle Aged; Norepinephrine; Oxygen Consumption; Prospective Studies; Ventricular Function, Left; Ventricular Premature Complexes

Topics: Aged, 80 and over; Anti-Arrhythmia Agents; Antihypertensive Agents; Atorvastatin; Atrial Fibrillation; Bone Density Conservation Agents; Deprescriptions; Digoxin; Diltiazem; Diuretics; Drug Overdose; Factor Xa Inhibitors; Female; Furosemide; Heart Failure; Histamine H1 Antagonists, Non-Sedating; Histamine H2 Antagonists; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Ibandronic Acid; Lisinopril; Loratadine; Metoprolol; Polypharmacy; Pyrazoles; Pyridones; Ranitidine; Syncope

The aim of the study was to evaluate effectiveness and safety of angiotensin II receptor blockers and inhibitors of angiotensin-converting enzyme (ECE) for protective therapy following medicamentous cardioversion with propafen at a loading dose of 600 mg in patients with paroxysmal atrial fibrillation and arterial hypertension. 101 patients were divided in 2 groups. Group 1 included 75 patients who received ACE inhibitor lisinopril (10 mg BID) after recovery of sinus rhythm by propanorm. 26 patients of group 2 were treated with angiotensin II receptor blocker candesartan (8 mg daily). Combined treatment with angiotensin II receptor blocker and propafenone leads to cardioversion faster than therapy with ACR inhibitor. It is concluded that alternative approach to the maintenance of sinus rhythm using angiotensin II receptor blockers has advantages over traditional anti-arrhythmic therapy; it is well tolerated by the patients and produced no serious side effects.

Topics: Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Atrial Fibrillation; Benzimidazoles; Biphenyl Compounds; Blood Pressure; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follow-Up Studies; Heart Rate; Humans; Hypertension; Lisinopril; Male; Middle Aged; Propafenone; Tetrazoles; Treatment Outcome

A recent meta-analysis demonstrated that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce the incidence of new-onset atrial fibrillation by nearly 50%. However, the ability of ACE inhibitors or ARBs to prevent post-cardiothoracic surgery (CTS) atrial fibrillation, when used postoperatively, has yet to be evaluated.. To evaluate the impact of postoperative ACE inhibitor or ARB use on the incidence of post-CTS atrial fibrillation.. We performed a retrospective cohort study of propensity score matched patients who underwent CTS at a single institution from January 2004 through December 2005. Patients who received either an ACE inhibitor or an ARB within 24 hours of surgery were propensity score matched for common predictors of post-CTS atrial fibrillation (age >70 y, preoperative digoxin use, postoperative beta-blocker or amiodarone use, beta-blocker intolerance, valve surgery, male sex, and history of diabetes mellitus, smoking, chronic obstructive pulmonary disease, prior cardiothoracic surgery) in a 1:1 ratio with patients who did not receive an ACE inhibitor or an ARB. Multivariate logistic regression was used to generate adjusted odds ratios to minimize the impact of baseline confounders.. A total of 1469 patients underwent CTS during the study evaluation period. Postoperatively, 188 received an ACE inhibitor or an ARB and were matched to 188 control patients. Mean +/- SD age of matched patients was 68.1 +/- 11.8 years, 66% were men, 42% underwent valve surgery, and 69% and 35% received postoperative beta-blockade and amiodarone, respectively. Patients who received an ACE inhibitor or an ARB did not experience a significant reduction in post-CTS atrial fibrillation compared with control patients (adjusted OR 0.95; 95% CI 0.57 to 1.56; p = 0.83).. In this evaluation, postoperative ACE inhibitor or ARB use was not associated with a reduction in post-CTS atrial fibrillation. A study of preoperative, longer-term ACE inhibitor and/or ARB therapy is needed to determine the benefits of that strategy.

Topics: Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Atrial Fibrillation; Biphenyl Compounds; Cardiac Surgical Procedures; Cohort Studies; Female; Humans; Irbesartan; Lisinopril; Male; Postoperative Complications; Ramipril; Retrospective Studies; Tetrazoles; Valine; Valsartan

Choice of the optimal antiarrhythmic therapy still remains a challenge. Most frequently, antiarrhythmic agents used to reestablish and maintain sinus rhythm do not provide satisfactory clinical effect. Understanding electrophysiological mechanisms of initiation and maintenance of atrial fibrillation is the best way to develop optimal therapeutic approaches. This aim of this study was to assess the prospects of correcting paroxysmal (persistent) form of atrial fibrillation with termination treatment, ACE inhibitors, and omega-3-polyunsaturated fatty acids. The subjects of the study were 90 patients with documented episodes of atrial fibrillation of less than 48-hour duration. The observation lasted 12 months. The results show that "tablets in the pocket" strategy is the most effective and safe method of treatment of rare episodes of atrial fibrillation in patients with mild structural heart diseases; the terminating effectiveness of propanorm was 79% during hospital treatment and 88% in outpatients in the selected group of patients without a significant number of side effects. Treatment with lisinopril (dapril) was followed by a decrease in the number of paroxysms, duration of arrhythmia episodes, and a tendency to transformation into asymptomatic form. A possible mechanism of this positive effect of dapril on the paroxysmal form of atrial fibrillation is leveling of local electrophysiological effects of angiotensin II in a form of changing time of intra- and interventricular atrial conduction. Adding omega-3-polyunsaturated fatty acids to termination therapy decrease the number atrial fibrillation episodes and the time to their termination.

Topics: Adolescent; Adult; Angiotensin-Converting Enzyme Inhibitors; Atrial Fibrillation; Combined Modality Therapy; Electrocardiography, Ambulatory; Fatty Acids, Omega-3; Female; Humans; Lisinopril; Male; Middle Aged

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Atrial Fibrillation; Enalapril; Humans; Hypertension; Lisinopril; Lupus Erythematosus, Systemic; Male; Mitral Valve Insufficiency

The authors describe two hypertensive patients with paroxysmal auricular flutter or fibrillation. The arterial hypertension was suspected because of a hypertensive response in a treadmill stress test, confirmed by a 24-hour blood pressure ambulatory monitoring and there was no damage in target organs. They focus that auricular flutter/fibrillation may be related to "occult hypertension".

Topics: Atenolol; Atrial Fibrillation; Atrial Flutter; Blood Pressure Monitors; Diltiazem; Drug Therapy, Combination; Humans; Hypertension; Lisinopril; Male; Middle Aged; Verapamil