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Angiotensin II rece...
Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study
- Article/chapterEnglish2005
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Numbers
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LIBRIS-ID:oai:gup.ub.gu.se/58754
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https://gup.ub.gu.se/publication/58754URI
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https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-6291URI
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https://doi.org/10.1016/j.jacc.2004.10.068DOI
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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OBJECTIVES: This study was designed to evaluate whether different antihypertensive treatment regimens with similar blood pressure reduction have different effects on new-onset atrial fibrillation (AF). BACKGROUND: It is unknown whether angiotensin II receptor blockade is better than beta-blockade in preventing new-onset AF. METHODS: In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study 9,193 hypertensive patients and patients with electrocardiogram-documented left ventricular hypertrophy were randomized to once-daily losartan- or atenolol-based antihypertensive therapy. Electrocardiograms were Minnesota coded centrally, and 8,851 patients without AF by electrocardiogram or history, who were thus at risk of developing AF, were followed for 4.8 +/- 1.0 years. RESULTS: New-onset AF occurred in 150 patients randomized to losartan versus 221 to atenolol (6.8 vs. 10.1 per 1,000 person-years; relative risk 0.67, 95% confidence interval [CI] 0.55 to 0.83, p < 0.001) despite similar blood pressure reduction. Patients receiving losartan tended to stay in sinus rhythm longer (1,809 +/- 225 vs. 1,709 +/- 254 days from baseline, p = 0.057) than those receiving atenolol. Moreover, patients with new-onset AF had two-, three- and fivefold increased rates, respectively, of cardiovascular events, stroke, and hospitalization for heart failure. There were fewer composite end points (n = 31 vs. 51, hazard ratio = 0.60, 95% CI 0.38 to 0.94, p = 0.03) and strokes (n = 19 vs. 38, hazard ratio = 0.49, 95% CI 0.29 to 0.86, p = 0.01) in patients who developed new-onset AF in the losartan compared to the atenolol treatment arm of the study. Furthermore, Cox regression analysis showed that losartan (21% risk reduction) and new-onset AF both independently predicted stroke even when adjusting for traditional risk factors. CONCLUSIONS: Our novel finding is that new-onset AF and associated stroke were significantly reduced by losartan- compared to atenolol-based antihypertensive treatment with similar blood pressure reduction.
Subject headings and genre
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Adrenergic beta-Antagonists/*therapeutic use
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Aged
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Aged
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80 and over
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Angiotensin II Type 1 Receptor Blockers/*therapeutic use
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Atenolol/*therapeutic use
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Atrial Fibrillation/*drug therapy/mortality
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Cause of Death
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Cerebrovascular Accident/*drug therapy/mortality
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Double-Blind Method
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Female
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Humans
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Hypertension/*drug therapy/mortality
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Hypertrophy
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Left Ventricular/*drug therapy/mortality
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Losartan/*therapeutic use
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Male
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Middle Aged
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Prospective Studies
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Recurrence/prevention & control
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Risk Factors
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Survival Rate
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Adrenergic beta-Antagonists/*therapeutic use
Added entries (persons, corporate bodies, meetings, titles ...)
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Lehto, M.
(author)
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Gerdts, E.
(author)
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Olsen, M. H.
(author)
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Hornestam, Björn,1957Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute(Swepub:gu)xhorbj
(author)
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Dahlöf, Björn,1953Gothenburg University,Göteborgs universitet,Hjärt-kärlinstitutionen,Cardiovascular Institute(Swepub:gu)xdahbj
(author)
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Ibsen, H.
(author)
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Julius, S.
(author)
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Kjeldsen, S. E.
(author)
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Lindholm, Lars HUmeå universitet,Allmänmedicin(Swepub:umu)lali0003
(author)
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Nieminen, M. S.
(author)
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Devereux, R. B.
(author)
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Göteborgs universitetHjärt-kärlinstitutionen
(creator_code:org_t)
Related titles
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In:J Am Coll Cardiol: Elsevier BV45:5, s. 712-90735-1097
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Wachtell, K.
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Lehto, M.
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Gerdts, E.
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Olsen, M. H.
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Hornestam, Björn ...
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Dahlöf, Björn, 1 ...
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Ibsen, H.
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Julius, S.
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Kjeldsen, S. E.
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Lindholm, Lars H
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Nieminen, M. S.
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Devereux, R. B.
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J Am Coll Cardio ...
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University of Gothenburg
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Umeå University