CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

March 9th, 2011

ACTIVE I Examines Role for Irbesartan in AF Patients

The angiotensin-receptor blocker irbesartan does not significantly reduce cardiovascular events in patients with atrial fibrillation, according to the results of the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE I), published in the New England Journal of Medicine. Participants had been previously randomized in the ACTIVE A trial or the ACTIVE W trial.

More than 9,000 patients were randomized to irbesartan or placebo and followed for 4.1 years. Although patients treated with irbesartan had a significantly greater drop in blood pressure, there were no significant differences in either the first coprimary endpoint — the composite outcome of stroke, myocardial infarction, or death from vascular causes — or the second coprimary outcome, which consisted of the first composite outcome plus heart failure hospitalization. However, even though most patients were already taking an ACE inhibitor, there were significantly fewer hospitalizations for heart failure in the irbesartan group, a prespecified secondary outcome.

 

Categories: Electrophysiology, Heart Failure
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2 Responses to “ACTIVE I Examines Role for Irbesartan in AF Patients”

  1. Leon Hyman, Ms M.D. says:
    March 9, 2011 at 6:34 pm

    All this proves is that as add on or secondary therapy to an ace inhibitor, irbesartan doesn’t alter the primary outcomes, but it says nothing about the drug as first line therapy.

    Competing interests pertaining specifically to this post, comment, or both:
    none

  2. Tamrat Retta, MD, PhD says:
    March 15, 2011 at 4:15 pm

    Previous studies like TRANSCEND did indicate that combined use of ACEIs and ARBs have no benefit on patients similar to those included in the respective trials. In the trial in discussion, the reduction in hospitalization for heart failure in the irbesartan group may be due to the reduction in systolic blood pressure as indicated in the article. In such group of patients with atrial fibrillation (where the effect of the atrial kick is lost) and reduced ejection fraction (<45%) a modest systolic blood pressure reduction would probably have significant afterload reduction thereby improving the systemic flow.

    Competing interests pertaining specifically to this post, comment, or both:
    NONE