ARBs 'do not lower' AF incidence

AF Patients given valsartan had results similar to placebo in study.

Angiotensin II-receptor blockers (ARBs) do not reduce incidence of recurrent AF, a study of more than 1,400 patients published in the New England Journal of Medicine suggests.

Previous research had raised hopes that the drugs, which are indicated for hypertension and post-MI treatment, could also prevent AF-inducing changes to the structure of heart tissue through 'atrial remodelling'.

However, these studies either examined AF as a secondary outcome or were too small to definitely establish an effect of ARBs on AF incidence or recurrence.

Only four previous studies, involving a total of 665 patients, have examined the role of ARBs in the prevention of AF.

This latest study enrolled 1,442 patients who had a history of AF as well as underlying diabetes, cardiovascular disease and left atrial enlargement.

Patients in the study, named the GISSI-AF trial, were randomly assigned to receive the ARB valsartan at a dose of 320mg daily or a placebo.

After one year, AF had occurred in 51 per cent of patients given valsartan and 52 per cent of those receiving placebo, a difference that was not statistically significant. The results were consistent across all the predefined sub-groups studied.

'Our findings do not support the hypothesis of a beneficial role of blockers of the renin-angiotensin-aldosterone system in the prevention of recurrent AF,' the researchers said.

'In these patients, the addition of valsartan to established therapies for AF and for coexisting cardiovascular conditions did not reduce the risk of either a first recurrence or multiple recurrences of AF.'

The researchers pointed out that their trial had a relatively short period of clinical follow-up.

'However,' they said, 'we did not detect even a modest trend in favour of valsartan therapy during the course of our trial, suggesting that such an effect would not be anticipated with a longer follow-up period.'

tom.moberly@haymarket.com

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