1
|
Shiga T, Yoshioka K, Watanabe E, Omori H, Yagi M, Okumura Y, Matsumoto N, Kusano K, Oshiro C, Ikeda T, Takahashi N, Komatsu T, Suzuki A, Suzuki T, Sato Y, Yamashita T. Paroxysmal atrial fibrillation recurrences and quality of life in symptomatic patients: A crossover study of flecainide and pilsicainide. J Arrhythm 2017; 33:310-317. [PMID: 28765762 PMCID: PMC5529594 DOI: 10.1016/j.joa.2017.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 12/02/2022] Open
Abstract
Background The therapeutic goals of atrial fibrillation (AF) patients are to reduce symptoms and prevent severe complications associated with AF. This study compared the efficacy of flecainide versus pilsicainide in reducing the frequency of AF and improving quality of life (QOL) in symptomatic paroxysmal AF patients without structural heart disease. Methods The Atrial Fibrillation and Quality Of Life (AF-QOL) study was a prospective, multicenter, randomized, open-label crossover study that compared flecainide and pilsicainide as antiarrhythmic drug therapy. Patients were randomized to receive 3 months of treatment with flecainide twice daily or pilsicainide 3 times daily. Each treatment consisted of a dose-finding phase (weeks 1–4) and an efficacy phase (weeks 5–12). Forty-three patients completed the trial. The main outcome was the number of days with documented AF episodes using a patient-operated electrocardiogram. QOL questionnaires (SF-36 and AF-specific QOL scores) were also completed. Results The median (range) AF frequencies (days/8 weeks) were 2 (0–50) in the flecainide treatment group and 1 (0–54) in the pilsicainide treatment group (no significant between-group difference). No significant difference in the first recurrence of AF during the efficacy phase was noted between flecainide and pilsicainide treatments. The frequency and severity scores of AF-related symptoms improved from baseline to the end of the treatment periods. No significant differences in SF-36 or AF-related QOL scores were noted between the treatment groups. Conclusions This study found no difference in AF frequency or QOL between symptomatic paroxysmal AF patients who received flecainide or pilsicainide.
Collapse
Affiliation(s)
- Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women׳s Medical University, Tokyo, Japan
| | - Koichiro Yoshioka
- Department of Cardiovascular Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hisako Omori
- Department of Medicine, Tokyo Women׳s Medical University Medical Center East, Tokyo, Japan
| | - Masahiro Yagi
- Division of Cardiology, Sendai Cardiovascular Center, Sendai, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Naoki Matsumoto
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Takashi Komatsu
- Division of Cardioangiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women׳s Medical University, Tokyo, Japan
| | - Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women׳s Medical University, Tokyo, Japan
| | - Yasuto Sato
- Department of Public Health, Tokyo Women׳s Medical University, Tokyo, Japan
| | | | | |
Collapse
|
2
|
Grassi G. Sympathomodulatory Effects of Antihypertensive Drug Treatment. Am J Hypertens 2016; 29:665-75. [PMID: 26888777 DOI: 10.1093/ajh/hpw012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/20/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND An activation of sympathetic neural influences to the heart and peripheral circulation has been shown to represent a hallmark of the essential hypertensive state, adrenergic neural factors participating together with other variables at the development and progression of the high blood pressure state as well as of the hypertension-related target organ damage. This represents the rationale for employing in hypertension treatment drugs which combine the blood pressure-lowering properties with the modulatory effects on the sympathetic neural function. METHODS AND RESULTS Several studies published during the past 40 years have investigated the impact of antihypertensive drugs on the sympathetic target as assessed by indirect and direct approaches. In the present paper, the effects of different monotherapies or combination drug treatment used in hypertension to lower elevated blood pressure values on various adrenergic markers will be examined. This will be followed by a discussion of the (i) hemodynamic and nonhemodynamic consequences of employing antihypertensive drugs with sympathomodulatory or sympathoexcitatory properties and (ii) mechanisms potentially responsible for the adrenergic responses to a given antihypertensive drug. The final part of this review will address the questions still open related to the impact of antihypertensive drug treatment on sympathetic function. Two questions in particular will be examined, i.e., whether antihypertensive drugs with sympathomodulatory properties may be capable to fully restore a "normal" adrenergic drive and how far sympathetic activity should be reduced in hypertensive patients. CONCLUSION Future investigations aimed at answering these questions will be needed in order to improve cardiovascular protection in treated hypertensive patients.
Collapse
Affiliation(s)
- Guido Grassi
- Clinica Medica, Dipartimento di Medicina e Chirurgia, Universita` Milano-Bicocca, Milano, Italy; IRCCS Multimedica, Sesto San Giovanni, Milano, Italy.
| |
Collapse
|
4
|
Bramlage P, Wolf WP, Fronk EM, Stuhr T, Erdlenbruch W, Wasem J, Ketelhut R, Schmieder RE. Improving quality of life in hypertension management using a fixed-dose combination of olmesartan and amlodipine in primary care. Expert Opin Pharmacother 2010; 11:2779-90. [PMID: 20929435 DOI: 10.1517/14656566.2010.521499] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess quality of life (QoL) in unselected patients in primary care treated with a fixed-dose combination of olmesartan and amlodipine. Research design and methods. Multicenter, noninterventional, noncontrolled observational study in 8241 patients seen by 2187 physicians over 12 - 18 weeks. MAIN OUTCOME MEASURES Changes in QoL were assessed by using the Short Form 12 (SF-12) questionnaire completed by 5434 patients (65.9%) at baseline and 4924 patients (59.8%) at the follow-up visit. RESULTS Patients had a mean age of 62.8 ± 11.8 years (48.1% female), mean blood pressure [BP] at baseline was 161.8 ± 16.6/93.6 ± 10.2 mmHg and 74.8% had at least one co-morbid risk factor or condition. All 12 items of the SF-12 improved over the observational period (p < 0.0001) as did the physical (46.8 vs 40.4; p < 0.0001) and mental summary scores (52.4 vs 47.5; p < 0.0001). Correlations of changes in systolic and diastolic BP, pulse pressure and heart rate with scores were significant, although weak (maximum -0.2055 for physical health and changes in systolic blood pressure). CONCLUSIONS The fixed-dose combination of olmesartan and amlodipine significantly improves QoL in an unselected population of patients in primary-care practice. This might translate into improved patient compliance and improved long-term antihypertensive efficacy.
Collapse
Affiliation(s)
- Peter Bramlage
- Institute for Cardiovascular Pharmacology and Epidemiology, Mahlow, Germany.
| | | | | | | | | | | | | | | |
Collapse
|