Enhanced cardiovascular morbidity and mortality during rhythm control treatment in persistent atrial fibrillation in hypertensives: data of the RACE study.

AIM To investigate the influence of hypertension on morbidity and mortality during rate and rhythm control in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS In the RAte Control vs. Electrical cardioversion (RACE) study, 522 patients (256 with hypertension) were randomized to rate or rhythm control. The occurrence of cardiovascular morbidity and mortality was compared between patients with and without hypertension. Patients with hypertension were older (69 +/- 8 vs. 67 +/- 9 years, P = 0.01), more female (P < 0.001), had more diabetes (P = 0.005), a higher CHADS(2) score (2.2 +/- 1.0 vs. 1.0 +/- 0.9, P < 0.001), and higher systolic and diastolic blood pressures. Septal and posterior wall thicknesses were higher in hypertensives. Complaints related to AF were similar. After a median follow-up of 2.4 (range 0-3.4) years more endpoints occurred in hypertensives (25 vs. 15%). Randomized treatment strategy, i.e. rate or rhythm control, influenced the occurrence of the primary endpoint only in hypertensives. Hypertensives treated with rhythm control experienced most endpoints (incidence rates/100 person-years 13.3 vs. 7.2, relative risk 0.5 [0.3-0.9], P = 0.02), mainly thromboembolic complications, adverse effects of antiarrhythmics, and pacemaker implantations. CONCLUSION In persistent AF patients with hypertension, a pharmacological rhythm control approach is associated with enhanced cardiovascular morbidity and mortality. Therefore, rate-control strategy should be considered in these patients.

[1]  M. Brodsky,et al.  Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. , 2005, Journal of the American College of Cardiology.

[2]  E. Kaufman,et al.  Occurrence and Characteristics of Stroke Events in the Atrial Fibrillation Follow-up Investigation of Sinus Rhythm Management (AFFIRM) Study , 2005 .

[3]  M. Nieminen,et al.  Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: The Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. , 2005, Journal of the American College of Cardiology.

[4]  G. Berglund,et al.  Risk Factors for Stroke in Subjects With Normal Blood Pressure: A Prospective Cohort Study , 2005, Stroke.

[5]  G. Breithardt,et al.  Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial. , 2004, European heart journal.

[6]  M. Domanski,et al.  Relationships Between Sinus Rhythm, Treatment, and Survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study , 2004, Circulation.

[7]  R. Cooper,et al.  Hypertension Treatment and Control in Five European Countries, Canada, and the United States , 2004, Hypertension.

[8]  Ihab Hajjar,et al.  Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. , 2003, JAMA.

[9]  U. Tebbe,et al.  Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. , 2003, Journal of the American College of Cardiology.

[10]  H. Crijns,et al.  A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. , 2002, The New England journal of medicine.

[11]  H. Crijns,et al.  A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation , 2002 .

[12]  A L Waldo,et al.  A comparison of rate control and rhythm control in patients with atrial fibrillation. , 2002, The New England journal of medicine.

[13]  L. Weinehall,et al.  High remaining risk in poorly treated hypertension: the ‘rule of halves’ still exists , 2002, Journal of hypertension.

[14]  Martha J. Radford,et al.  Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation , 2001 .

[15]  S. Hohnloser,et al.  Rhythm or rate control in atrial fibrillation-pharmacological intervention in atrial fibrillation (PIAF): a randomised trial , 2001 .

[16]  P. Whelton,et al.  Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. , 2001, Archives of internal medicine.

[17]  B Neal,et al.  Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials , 2000, The Lancet.

[18]  B. Psaty,et al.  Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients. , 2000, Stroke.

[19]  P A Wolf,et al.  Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. , 1998, The American journal of cardiology.

[20]  Joël Ménard,et al.  Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial , 1998, The Lancet.

[21]  D. Levy,et al.  Isolated systolic hypertension: an important cardiovascular risk factor. , 1998, Blood pressure.

[22]  L H Kuller,et al.  Incidence of and risk factors for atrial fibrillation in older adults. , 1997, Circulation.

[23]  A J Tajik,et al.  Noninvasive doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. , 1996, Journal of the American College of Cardiology.

[24]  R. Vasan,et al.  The progression from hypertension to congestive heart failure. , 1996, JAMA.

[25]  W. Kannel,et al.  Framingham study insights into hypertensive risk of cardiovascular disease. , 1995, Hypertension research : official journal of the Japanese Society of Hypertension.

[26]  W. Kannel,et al.  Hypertension as a Risk Factor for Cardiac Events—Epidemiologic Results of Long‐Term Studies , 1993, Journal of cardiovascular pharmacology.

[27]  Predictors of Thromboembolism in Atrial Fibrillation: II. Echocardiographic Features of Patients at Risk , 1992, Annals of Internal Medicine.

[28]  Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. , 1991, JAMA.