Incident atrial fibrillation in elderly patients with isolated systolic hypertension significantly increased the risk for total cardiovascular events (RR 1.69; 95% CI 1.21-2.36) and all-cause mortality.
RCT (n=4,736)
double-blind
randomly assigned
Does stepped care treatment with chlorthalidone and atenolol prevent the onset of atrial fibrillation in elderly patients with isolated systolic hypertension?
In elderly patients with isolated systolic hypertension, incident atrial fibrillation is infrequent but strongly associated with increased risks of cardiovascular events, heart failure, and long-term mortality, and its onset is not prevented by chlorthalidone and atenolol.
Estimación del efecto: RR 1.69 (95% CI 1.21-2.36)
We performed a post hoc analysis of the Systolic Hypertension in the Elderly Program database to assess the incidence of atrial fibrillation in the elderly hypertensive population, its influence on cardiovascular events, and whether antihypertensive treatment can prevent its onset. The Systolic Hypertension in the Elderly Program was a double-blind placebo-controlled trial in 4736 subjects with isolated systolic hypertension aged >or=60 years. Atrial fibrillation was an exclusion criterion from the trial. Participants were randomly assigned to stepped care treatment with chlorthalidone and atenolol (n=2365) or placebo (n=2371). The occurrence of atrial fibrillation and cardiovascular events over 4.7 years as well as the determination of cause of death at 4.7 and 14.3 years were followed. Ninety-eight subjects (2.06%) developed atrial fibrillation over 4.7 years mean follow-up, without significant difference between treated and placebo groups. Atrial fibrillation increased the risk for: total cardiovascular events (RR 1.69; 95% CI 1.21 to 2.36), rapid death (RR 3.29; 95% CI 1.08 to 10.00), total (RR 5.10; 95% CI 3.12 to 8.37) and nonfatal left ventricular failure (RR 5.31; 95% CI 3.09 to 9.13). All-cause and total cardiovascular death were significantly increased in the atrial fibrillation group at 4.7 years (HR 3.44; 95% CI 2.18 to 5.42; HR 2.39; 95% CI 1.05 to 5.43) and 14.3 years follow-up (HR 2.33; 95% CI 1.83 to 2.98; HR 2.21; 95% CI 1.54 to 3.17). Atrial fibrillation increased the risk for total cardiovascular events, rapid death, and left ventricular failure. All-cause mortality and total cardiovascular mortality were significantly increased in hypertensives with atrial fibrillation at 4.7 and 14.3 years follow-up.
Vagaonescu et al. (Tue,) conducted a rct in Isolated systolic hypertension (n=4,736). Stepped care treatment with chlorthalidone and atenolol vs. Placebo was evaluated on Total cardiovascular events (associated with incident atrial fibrillation) (RR 1.69, 95% CI 1.21-2.36). Incident atrial fibrillation in elderly patients with isolated systolic hypertension significantly increased the risk for total cardiovascular events (RR 1.69; 95% CI 1.21-2.36) and all-cause mortality.