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Risk for Incident Atrial Fibrillation in Patients Who Receive Antihypertensive Drugs: A Nested Case–Control Study

Beat A. Schaer, MD; Cornelia Schneider, MSc; Susan S. Jick, DSc; David Conen, MD, MPH; Stefan Osswald, MD; and Christoph R. Meier, PhD, MSc
[+] Article and Author Information

From University Hospital, Basel, Switzerland, and Boston University Medical Center, Lexington, Massachusetts.


Note: Dr. Schaer and Ms. Schneider contributed equally to this paper.

Potential Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol: Available from the authors on written request and with written agreement. Statistical code: Portions available from the authors on written request and with written agreement. Data set: Not available to persons or groups who do not have a valid GPRD license provided by the Medicines and Healthcare Products Regulatory Agency; for those with a valid license, parts of the data are available from the authors on written request and with written agreement.

Requests for Single Reprints: Christoph R. Meier, PhD, MSc, Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland; e-mail, meierch@uhbs.ch.

Current Author Addresses: Drs. Schaer, Conen, and Osswald: Division of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.

Ms. Schneider: Basel Pharmacoepidemiology Unit, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.

Dr. Jick: Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421.

Dr. Meier: Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031 Basel, Switzerland.

Author Contributions: Conception and design: B.A. Schaer, C. Schneider, C.R. Meier.

Analysis and interpretation of the data: B.A. Schaer, C. Schneider, D. Conen, S. Osswald, C.R. Meier.

Drafting of the article: B.A. Schaer, C. Schneider, S. Osswald, C.R. Meier.

Critical revision of the article for important intellectual content: B.A. Schaer, S.S. Jick, D. Conen, S. Osswald, C.R. Meier.

Final approval of the article: B.A. Schaer, C. Schneider, S.S. Jick, D. Conen, S. Osswald, C.R. Meier.

Statistical expertise: D. Conen, C.R. Meier.

Administrative, technical, or logistic support: S.S. Jick, C.R. Meier.

Collection and assembly of data: C.R. Meier.


Ann Intern Med. 2010;152(2):78-84. doi:10.7326/0003-4819-152-2-201001190-00005
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Background: Different antihypertensive drug classes may alter risk for atrial fibrillation. Some studies suggest that drugs that interfere with the renin–angiotensin system may be favorable because of their effect on atrial remodeling.

Objective: To assess and compare the relative risk for incident atrial fibrillation among hypertensive patients who receive antihypertensive drugs from different classes.

Design: Nested case–control analysis.

Setting: The United Kingdom–based General Practice Research Database, a well-validated primary care database comprising approximately 5 million patient records.

Patients: 4661 patients with atrial fibrillation and 18 642 matched control participants from a population of 682 993 patients treated for hypertension.

Measurements: A comparison of the risk for atrial fibrillation among hypertensive users of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II–receptor blockers (ARBs), or β-blockers with the reference group of users of calcium-channel blockers. Patients with clinical risk factors for atrial fibrillation were excluded.

Results: Current exclusive long-term therapy with ACE inhibitors (odds ratio [OR], 0.75 [95% CI, 0.65 to 0.87]), ARBs (OR, 0.71 [CI, 0.57 to 0.89]), or β-blockers (OR, 0.78 [CI, 0.67 to 0.92]) was associated with a lower risk for atrial fibrillation than current exclusive therapy with calcium-channel blockers.

Limitation: Blood pressure changes during treatment courses could not be evaluated, and risk for bias by indication cannot be fully excluded in an observational study.

Conclusion: In hypertensive patients, long-term receipt of ACE inhibitors, ARBs, or β-blockers reduces the risk for atrial fibrillation compared with receipt of calcium-channel blockers.

Primary Funding Source: None.

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Summary for Patients

Effect of Antihypertensive Drugs on Risk for Atrial Fibrillation

The summary below is from the full report titled “Risk for Atrial Fibrillation in Patients Who Receive Antihypertensive Drugs. A Nested Case–Control Study.” It is in the 19 January 2009 issue of Annals of Internal Medicine (volume 152, pages 78-84). The authors are B.A. Schaer, C. Schneider, S.S. Jick, D. Conen, S. Osswald, and C.R. Meier.

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