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)

Takeshi Yamashita, Hiroshi Inoue, Ken Okumura, Itsuo Kodama, Yoshifusa Aizawa, Hirotsugu Atarashi, Tohru Ohe, Hiroshi Ohtsu, Takao Kato, Shiro Kamakura, Koichiro Kumagai, Yoshihisa Kurachi, Yukihiro Koretsune, Tetsunori Saikawa, Masayuki Sakurai, Toshiaki Sato, Kaoru Sugi, Haruaki Nakaya, Makoto Hirai, Atsushi HirayamaMasahiko Fukatani, Hideo Mitamura, Tsutomu Yamazaki, Eiichi Watanabe, Satoshi Ogawa

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

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). Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish
Pages (from-to)473-479
Number of pages7
JournalEuropace
Volume13
Issue number4
DOIs
Publication statusPublished - 01-04-2011

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Angiotensin Receptor Antagonists
Calcium Channel Blockers
Atrial Fibrillation
Hypertension
Therapeutics
Amlodipine
Quality of Life
Blood Pressure
Cardiac Arrhythmias
Japan

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Yamashita, Takeshi ; Inoue, Hiroshi ; Okumura, Ken ; Kodama, Itsuo ; Aizawa, Yoshifusa ; Atarashi, Hirotsugu ; Ohe, Tohru ; Ohtsu, Hiroshi ; Kato, Takao ; Kamakura, Shiro ; Kumagai, Koichiro ; Kurachi, Yoshihisa ; Koretsune, Yukihiro ; Saikawa, Tetsunori ; Sakurai, Masayuki ; Sato, Toshiaki ; Sugi, Kaoru ; Nakaya, Haruaki ; Hirai, Makoto ; Hirayama, Atsushi ; Fukatani, Masahiko ; Mitamura, Hideo ; Yamazaki, Tsutomu ; Watanabe, Eiichi ; Ogawa, Satoshi. / 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). In: Europace. 2011 ; Vol. 13, No. 4. pp. 473-479.
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abstract = "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). Published on behalf of the European Society of Cardiology. All rights reserved.",
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Yamashita, T, Inoue, H, Okumura, K, Kodama, I, Aizawa, Y, Atarashi, H, Ohe, T, Ohtsu, H, Kato, T, Kamakura, S, Kumagai, K, Kurachi, Y, Koretsune, Y, Saikawa, T, Sakurai, M, Sato, T, Sugi, K, Nakaya, H, Hirai, M, Hirayama, A, Fukatani, M, Mitamura, H, Yamazaki, T, Watanabe, E & Ogawa, S 2011, '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)', Europace, vol. 13, no. 4, pp. 473-479. https://doi.org/10.1093/europace/euq439

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). / Yamashita, Takeshi; Inoue, Hiroshi; Okumura, Ken; Kodama, Itsuo; Aizawa, Yoshifusa; Atarashi, Hirotsugu; Ohe, Tohru; Ohtsu, Hiroshi; Kato, Takao; Kamakura, Shiro; Kumagai, Koichiro; Kurachi, Yoshihisa; Koretsune, Yukihiro; Saikawa, Tetsunori; Sakurai, Masayuki; Sato, Toshiaki; Sugi, Kaoru; Nakaya, Haruaki; Hirai, Makoto; Hirayama, Atsushi; Fukatani, Masahiko; Mitamura, Hideo; Yamazaki, Tsutomu; Watanabe, Eiichi; Ogawa, Satoshi.

In: Europace, Vol. 13, No. 4, 01.04.2011, p. 473-479.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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)

AU - Yamashita, Takeshi

AU - Inoue, Hiroshi

AU - Okumura, Ken

AU - Kodama, Itsuo

AU - Aizawa, Yoshifusa

AU - Atarashi, Hirotsugu

AU - Ohe, Tohru

AU - Ohtsu, Hiroshi

AU - Kato, Takao

AU - Kamakura, Shiro

AU - Kumagai, Koichiro

AU - Kurachi, Yoshihisa

AU - Koretsune, Yukihiro

AU - Saikawa, Tetsunori

AU - Sakurai, Masayuki

AU - Sato, Toshiaki

AU - Sugi, Kaoru

AU - Nakaya, Haruaki

AU - Hirai, Makoto

AU - Hirayama, Atsushi

AU - Fukatani, Masahiko

AU - Mitamura, Hideo

AU - Yamazaki, Tsutomu

AU - Watanabe, Eiichi

AU - Ogawa, Satoshi

PY - 2011/4/1

Y1 - 2011/4/1

N2 - 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). Published on behalf of the European Society of Cardiology. All rights reserved.

AB - 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). Published on behalf of the European Society of Cardiology. All rights reserved.

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