Reduced incidence of new-onset atrial fibrillation with angiotensin II receptor blockade: The VALUE trial

Roland E. Schmieder, Sverre E. Kjeldsen, Stevo Julius, Gordon T. McInnes, Alberto Zanchetti, Tsushung A. Hua

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and increases cardiovascular risk in hypertensive patients. Therefore, in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) a prespecified objective was to compare the effects of valsartan and amlodipine on new-onset AF. METHODS: A total of 15 245 hypertensive patients at high cardiovascular risk received valsartan 80-160 mg/day or amlodipine 5-10 mg/day combined with additional antihypertensive agents. Electrocardiograms were obtained every year and analyzed centrally for evidence of left ventricular hypertrophy and new-onset AF. RESULTS: At baseline, AF was diagnosed in 2.6% of 7649 valsartan recipients and 2.6% of 7596 amlodipine recipients. During antihypertensive treatment the incidence of at least one documented occurrence of new-onset AF was 3.67% with valsartan and 4.34% with amlodipine {unadjusted hazard ratio 0.843, [95% confidence interval (CI): 0.713, 0.997], P = 0.0455}. The incidence of persistent AF was 1.35% with valsartan and 1.97% with amlodipine [unadjusted hazard ratio 0.683 (95% CI: 0.525, 0.889), P = 0.0046]. CONCLUSIONS: Valsartan-based treatment reduced the development of new-onset AF, particularly sustained AF in hypertensive patients, compared with amlodipine-based therapy. These findings suggest that angiotensin II receptor blockers may result in greater benefits than calcium antagonists in hypertensive patients at risk of new-onset AF.

Original languageEnglish
Pages (from-to)403-411
Number of pages9
JournalJournal of Hypertension
Issue number3
Publication statusPublished - Mar 2008


  • Angiotensin receptor blocker
  • Arterial hypertension
  • Atrial fibrillation
  • Prevention

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology


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