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.
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