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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events [ACTIVE-I; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00249795\u0026amp;atom=%2Fspmdc%2F9%2F4%2F12.2.atom\u0022\u003ENCT00249795\u003C\/a\u003E], treatment with irbesartan failed to lower the risk of stroke, myocardial infarction, and vascular death compared with placebo in patients with atrial fibrillation (AF). However, irbesartan may have a role in preventing heart failure, recurrent embolic events, and cardiovascular hospitalizations in patients with AF.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE-I; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00249795\u0026amp;atom=%2Fspmdc%2F9%2F4%2F12.2.atom\u0022\u003ENCT00249795\u003C\/a\u003E), treatment with irbesartan failed to lower the risk of stroke, myocardial infarction (MI), and vascular death compared with placebo in patients with atrial fibrillation (AF). However, irbesartan may have a role in preventing heart failure (HF), recurrent embolic events, and cardiovascular (CV) hospitalizations in patients with AF.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe ACTIVE program comprised three clinical trials that enrolled patients with documented AF and at least one additional risk factor for stroke, including ACTIVE-W (clopidogrel plus aspirin vs warfarin), ACTIVE-A (clopidogrel plus aspirin vs aspirin monotherapy), and ACTIVE-I. Salim Yusuf, MD, DPhil, McMaster University, Ontario, Canada, presented preliminary results from the ACTIVE-I trial, which was designed to evaluate the effect of additional blood pressure (BP) reduction with an angiotensin receptor blocker (ARB) on common complications of AF, including HF, stroke, and other embolic events.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn ACTIVE-I, patients who had a systolic BP \u0026gt;110 mm Hg and were not being treated with an ARB were randomly assigned to irbesartan at a target dose of 300 mg\/day (n=4518) or placebo (n=4498). At baseline, patients generally were treated with multiple CV medications, including angiotensin-converting enzyme (ACE) inhibitors (60%), aspirin (59%), beta-blockers (54%), diuretic therapy (54%), vitamin K antagonists (38%), digoxin (35%), calcium channel blockers (27%), and antiarrhythmics (23%).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EOn top of this extensive background therapy, irbesartan provided an additional reduction in BP (6.8\/4.5 mm Hg) compared with placebo (3.9\/2.6 mm Hg). However, ACTIVE-I failed to reach either of its two primary endpoints. The composite endpoint of stroke, MI, and vascular death occurred with equal frequency in the irbesartan and placebo groups (HR, 0.99; p=0.85), and a similar proportion reached the composite co-primary endpoint of the above plus HF hospitalization (HR, 0.94; p=0.12). Only one component of the primary endpoint, HF hospitalization, occurred less frequently in the irbesartan group (HR, 0.86; p=0.018).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ECompared with placebo, irbesartan was associated with a similar frequency of total strokes (2.3% vs 2.1%; p=0.21) but fewer hemorrhagic strokes (0.2% vs 0.4%; p=0.010). Irbesartan also reduced the composite endpoint of stroke, transient ischemic attacks, and noncentral nervous system embolism (HR, 0.87; p=0.024). In particular, the reduction of recurrent embolic events in the irbesartan group (39.6% vs 44.3%; p=0.016) contributed to significantly fewer CV hospitalizations (3817 vs 4509 admissions; p=0.003) and fewer total days of hospitalization (36,440 vs 39,971 days; p\u0026lt;0.001) compared with placebo.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EFindings from ACTIVE-I illustrate the limited benefit of a modest reduction in BP with irbesartan in the setting of AF, in which the prevalence of hypertension is high and HF is more common than stroke, Dr. Yusuf said. More aggressive BP lowering with multiple antihypertensive agents may result in an even greater clinical benefit, he concluded.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/4\/12.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmisp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}