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Intensive Blood Pressure Lowering for Prevention of Atrial Fibrillation
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Intensive Blood Pressure Lowering for Prevention of Atrial Fibrillation

Professor Clara Chow, Institution: University of Sydney

2018 Vanguard Grant

Years funded: 2019-2021


Atrial fibrillation (AF) is a major cause of mortality and morbidity globally. Hypertension is a recognized risk factor for AF and systematic reviews shows that blood pressure (BP) lowering is associated with reduced risk of developing AF. Patients with a history of previous AF are at risk of developing further AF. It is unclear whether more intensive BPlowering could reduce future AF burden. The proposed study aims to examine the feasibility and effectiveness of intensive BP lowering to reduce AF burden in a pilot study of 60 patients. It will provide the information needed to enable the examination of this concept in a large-scale randomised controlled trial.

We will examine whether patients randomised to intensive BP-lowering in addition to usual care will have reduced AF burden as measured by continuous cardiac monitoring using an implanted device. Intensive BP-lowering will be achieved by randomising patients to the quadpill (single pill with irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol2.5 mg) or to placebo on top of usual care. Patients will be eligible if they have non-permanent AF (paroxysmal AF identified by continuous cardiac monitoring or persistent AF cardioverted to sinus rhythm), have a baseline BP >130/80 and can tolerate all components of the quadpill.

Usual care will be management of BP according to current guidelines, with guidance provided on what medications can be used e.g. irbesartan up to 262.5mg, amlodipine up to 8.75mg, indapamide up to 1.875 mg and bisoprolol up to 7.5mg – or equivalent doses in equivalent classes.

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