European Heart Journal Advance Access originally published online on February 1, 2007
European Heart Journal 2007 28(6):741-751; doi:10.1093/eurheartj/ehl436
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Enhanced cardiovascular morbidity and mortality during rhythm control treatment in persistent atrial fibrillation in hypertensives: data of the RACE study
1 Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
2 Department of Cardiology, University Hospital, Maastricht, The Netherlands
Received 7 August 2006; revised 27 October 2006; accepted 23 November 2006; online publish-ahead-of-print 1 February 2007.
* Corresponding author. Tel: +31 50 3612355; fax: +31 50 3614391. E-mail address: i.c.van.gelder{at}thorax.umcg.nl
Aim To investigate the influence of hypertension on morbidity and mortality during rate and rhythm control in patients with persistent atrial fibrillation (AF).
Methods and results In the RAte Control vs. Electrical cardioversion (RACE) study, 522 patients (256 with hypertension) were randomized to rate or rhythm control. The occurrence of cardiovascular morbidity and mortality was compared between patients with and without hypertension. Patients with hypertension were older (69 ± 8 vs. 67 ± 9 years, P = 0.01), more female (P < 0.001), had more diabetes (P = 0.005), a higher CHADS2 score (2.2 ± 1.0 vs. 1.0 ± 0.9, P < 0.001), and higher systolic and diastolic blood pressures. Septal and posterior wall thicknesses were higher in hypertensives. Complaints related to AF were similar. After a median follow-up of 2.4 (range 0–3.4) years more endpoints occurred in hypertensives (25 vs. 15%). Randomized treatment strategy, i.e. rate or rhythm control, influenced the occurrence of the primary endpoint only in hypertensives. Hypertensives treated with rhythm control experienced most endpoints (incidence rates/100 person-years 13.3 vs. 7.2, relative risk 0.5 [0.3–0.9], P = 0.02), mainly thromboembolic complications, adverse effects of antiarrhythmics, and pacemaker implantations.
Conclusion In persistent AF patients with hypertension, a pharmacological rhythm control approach is associated with enhanced cardiovascular morbidity and mortality. Therefore, rate-control strategy should be considered in these patients.
Key Words: Atrial fibrillation • Hypertension • Cardioversion • Morbidity • Mortality
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