lisinopril and Atrial-Flutter

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

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