1. Does the Choice of Antihypertensive Agent Affect Risk for AFib? Summary and Comment by Joel M. Gore, MD Published in Journal Watch Cardiology February 3, 2010Journal Watch Cardiology In a case-control study, ACE inhibitors, ARBs, and beta-blockers were associated with a reduction in incident AF compared with calcium-channel blockers. CopyrightCopyright © 2010. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

2. Covering Schaer BA et al. Risk for incident atrial fibrillation in patients who receive antihypertensive drugs: A nested case–control study. Ann Intern Med 2010 Jan 19; 152:78. CopyrightCopyright © 2010. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

3. Background Hypertension is a known risk factor for atrial fibrillation. To assess and compare the relative risk for incident AF among patients taking different classes of antihypertensive drugs, investigators used a British general practice database to conduct a nested case-control analysis. All participants had hypertension diagnoses and had received one or more prescriptions for an ACE inhibitor, angiotensin-receptor blocker, beta-blocker, calcium-channel blocker, diuretic, or any combination of these drugs. CopyrightCopyright © 2010. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

4. The Research Of a total of 682,993 antihypertensive drug recipients, 4661 were diagnosed with AF and met inclusion criteria for the analysis. Almost two thirds of the case patients were 70 or older at first AF diagnosis. The investigators randomly identified 18,642 age- and sex-matched participants without AF from the study population as a control group. Obese patients had a higher risk for AF than nonobese patients, whereas current smokers had a lower risk for AF than nonsmokers. CopyrightCopyright © 2010. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

5. The Research The reference group consisted of patients receiving calcium-channel blockers. Compared with the reference group, long-term (≥12 prescriptions) ACE inhibitor recipients had a significant 25% reduction — and long- term ARB recipients had a significant 29% reduction — in risk for incident AF. Patients who had received beta-blockers for at least 1 year had a significant 22% reduction in risk for AF. CopyrightCopyright © 2010. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

6. Comment In patients with hypertension, different classes of drugs can have different effects on risk for future AF. Clinicians should consider this possibility when prescribing drugs for hypertension. In particular, avoiding calcium-channel blockers as front-line therapy in elders might reduce their risk for AF. CopyrightCopyright © 2010. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

7. About Journal Watch Journal Watch helps physicians and allied heath professionals save time and stay informed by providing brief, clearly written, clinically focused perspectives on the medical developments that affect practice. Journal Watch is an independent, trustworthy source, from the publishers of the New England Journal of Medicine. These slides were derived from Journal Watch Cardiology.Journal Watch Cardiology The best way to stay informed with Journal Watch, is through our alerts. To sign up, visit the My Alerts page.My Alerts page CopyrightCopyright © 2010. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society