American Neurological Association
Lowering Blood Pressure Reduces Vascular Events in Patients with Atrial Fibrillation
Speaker: Hisatomi Arima, MD, PhD, Clinical Research Scientist, George Institute for International Health, and Lecturer,
University of Sydney, Sydney, New South Wales, Australia.
For most patients with atrial fibrillation (AF), routine lowering of blood pressure (BP) with an antihypertensive agent such as perindopril (Solvay) appears to provide protection against major vascular events such as stroke, non-fatal myocardial infarction (MI), or vascular death even if they are taking anticoagulants to prevent stroke.
A subsidiary analysis of data from the Perindopril Protection against Recurrent Stroke Study (PROGRESS) showed the benefits of reducing BP in 6,105 patients with cerebrovascular disease. All patients were randomly selected to receive either (1) active treatment with canadian perindopril 2 to 4 mg plus the thiazide diuretic indapamide (Mylan/Parr) for those without an indication for, or a contraindication to, a diuretic or (2) a matching placebo. In this earlier study, treatment with the angio-tensin-converting enzyme (ACE)-inhibitor and the diuretic resulted in a 25% reduction in stroke risk.
The analysis focused on 476 patients with AF at baseline, of whom 51% were taking anticoagulants. Over 3.9 years of follow-up, the presence of AF increased the risk of major vascular events by 25% and stroke by 29%.
Active treatment with the diuretic reduced systolic BP by 7.3 mm Hg and diastolic BP by 3.4 mm Hg in patients with AF and reduced systolic BP by 9 mm Hg and dia-stolic BP by 4 mm Hg in patients without AF.
The corresponding reductions in the relative risk of major vascular events were 38% in patients with AF and 25% in patients without AF. Active treatment also reduced the relative risk of stroke by 34% in patients with AF and by 28% in those without AF.
It was estimated that one vascular event was avoided for every 11 patients with AF treated for five years, compared with one vascular event avoided among every 23 patients without AF. The benefits of BP lowering in patients with AF were achieved whether or not anticoagulant therapy was used and whether or not the patients had hypertension.