Candesartan, amlodipine offer similar benefits for paroxysmal AF with hypertension
MedWire News: Candesartan and amlodipine offer similar anti-arrhythmic benefits for paroxysmal atrial fibrillation (AF) associated with hypertension, an open-label trial suggests.
There was a similar, significant decrease in total AF days with the angiotensin receptor blocker (ARB) candesartan and the calcium channel blocker (CCB) amlodipine after up to a year of treatment in the Japanese Rhythm Management Trial II for AF (J-RHYTHM II).
Takeshi Yamashita (The Cardiovascular Institute, Tokyo, Japan) and colleagues say: "These data suggest that, for both patients and health-care providers, selection of anti-hypertensive drugs could be individualized from other patient characteristics."
The trial enrolled 318 patients at 48 sites throughout Japan who had experienced paroxysmal hypertension - defined as an episode with spontaneous termination within 7 days - within the past 6 months and had blood pressure of at least 140/90 mmHg.
Participants were randomly assigned to candesartan at an initial dose of 4-8 mg/day (maximum 12 mg/day) or amlodipine at an initial dose of 2.5 mg/day (maximum 5 mg/day).
If blood pressure did not reach the 130/85 mmHg target, other antihypertensives could be used. Anti-arrhythmic drugs were limited to several class I agents.
The primary endpoint was the difference in AF frequency between the pre-treatment period and the final month of follow up recorded using daily transtelephonic monitoring.
At baseline, the mean frequency of AF episodes was 3.8 per month in 158 patients randomly assigned to candesartan and 4.8 days per month in 160 assigned to amlodipine, a nonsignificant difference.
After treatment for up to 12 months, total AF frequency reduced to 2.1 days per month with candesartan and 2.4 days per month with amlodipine, again a nonsignificant difference.
There were also no significant differences in the secondary endpoints including development of persistent AF, changes in left atrial dimension, occurrence of cardiovascular events, or changes in quality of life.
In an editorial accompanying the study in the journal Europace, Andreas Goette (St Vincenz-Hospital Paderborn, Germany) noted the trial was open label with no placebo arm.
He said: "J-RHYTHM II has limitations and, therefore, the definite role of ACE inhibitors and ARBs in AF therapy remains unclear."
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By Anita Wilkinson