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document
Randomized trial of angiotensin II-receptor blocker vs. dihydropiridine calcium channel blocker in the treatment of paroxysmal atrial fibrillation with hypertension ( J-RHYTHM II study ) . AIMS Atrial fibrillation ( AF ) is a common arrhythmia frequently associated with hypertension . This study was designed to test the hypothesis that lowering blood pressure by angiotensin II-receptor blockers ( ARB ) has more beneficial effects than by conventional calcium channel blockers ( CCB ) on the frequency of paroxysmal AF with hypertension . METHODS AND RESULTS The Japanese Rhythm Management Trial II for Atrial Fibrillation ( J-RHYTHM II study ) is an open-label randomized comparison between an ARB ( candesartan ) and a CCB ( amlodipine ) in the treatment of paroxysmal AF associated with hypertension . Using daily transtelephonic monitoring , we examined asymptomatic and symptomatic paroxysmal AF episodes during a maximum 1 year treatment . The primary endpoint was the difference in AF frequency between the pre-treatment period and the final month of the follow-up . The secondary endpoints included cardiovascular events , development of persistent AF , left atrial dimension , and quality-of-life ( QOL ) . The study enrolled 318 patients ( 66 years , male/female 219/99 , 158 in the ARB group and 160 in the CCB group ) treated at 48 sites throughout Japan . At baseline , the frequency of AF episodes ( days/month ) was 3.8 ± 5.0 in the ARB group vs. 4.8 ± 6.3 in the CCB group ( not significant ) . During the follow-up , blood pressure was significantly lower in the CCB group than in the ARB group ( P < 0.001 ) . The AF frequency decreased similarly in both groups , and there was no significant difference in the primary endpoint between the two groups . There were no significant differences between the two groups in the development of persistent AF , changes in left atrial dimension , occurrence of cardiovascular events , or changes in QOL . CONCLUSIONS In patients with paroxysmal AF and hypertension , treatment of hypertension by candesartan did not have an advantage over amlodipine in the reduction in the frequency of paroxysmal AF ( umin CTR C000000427 ) .
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Intervention_Pharmacological
angiotensin II-receptor blocker
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Intervention_Pharmacological
dihydropiridine calcium channel blocker
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Intervention_Pharmacological
angiotensin II-receptor blockers ( ARB )
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Intervention_Pharmacological
conventional calcium channel blockers ( CCB )
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Intervention_Pharmacological
ARB ( candesartan )
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Intervention_Pharmacological
CCB ( amlodipine )
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Intervention_Pharmacological
ARB
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Intervention_Pharmacological
CCB
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Outcome_Physical
paroxysmal AF
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Outcome_Other
difference in AF frequency
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Outcome_Physical
cardiovascular events
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Outcome_Physical
development of persistent AF
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Outcome_Physical
left atrial dimension
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Outcome_Mental
quality-of-life ( QOL )
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Outcome_Physical
frequency of AF episodes
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Participant_Condition
paroxysmal atrial fibrillation with hypertension
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Participant_Condition
Japanese Rhythm Management Trial II for Atrial Fibrillation ( J-RHYTHM II study )
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Participant_Sample-size
318
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Participant_Age
66 years
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Participant_Sex
male/female
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Participant_Sample-size
219/99
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Participant_Sample-size
158
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Participant_Sample-size
160
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Participant_Condition
At baseline , the frequency of AF episodes ( days/month ) was 3.8 ± 5.0 in the ARB group vs.
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Participant_Condition
In patients with paroxysmal AF and hypertension