Journal article
Anti-hypertensive Drug Classes and Risk of New-Onset Atrial Fibrillation in Healthy Older Adults: A Post Hoc Analysis of ASPREE Trial
Drugs & aging, Vol.42(12), pp.1159-1167
12/2025
DOI: 10.1007/s40266-025-01258-6
PMID: 41091441
Abstract
Prior studies have suggested potential benefits of antihypertensive medication (AHM) in preventing atrial fibrillation. It remains uncertain whether these benefits are uniform across different AHM classes. This study aims to compare the risk of AF across AHM classes in older adults.
This study included 8942 individuals from a randomized trial of aspirin, who were aged ≥ 65 years, free of cardiovascular disease (CVD) and AF, treated with any AHM at baseline. Exposures of interest included four first-line AHM medications: angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics. Participants were assigned a diagnosis of probable, possible or no AF via a clinical algorithm. Possible AF cases were excluded. Cox proportional-hazards model was used to compare risk of probable AF among baseline users of different AHM classes, adjusting for potential confounders and blood pressure.
Over 4.5 years, 535 (6.0%) participants developed probable AF. CCB-based therapy, alone or in combination, showed the lowest AF risk among all classes (HR [95% CI] for CCB-based therapy versus ARB-, ACEI-, and diuretic-based therapy, alone or in combination: 0.74 [0.57-0.98], 0.85 [0.64-1.13], and 0.81 [0.62-1.06], respectively). A lower AF risk was also observed with CCB monotherapy (HR from 0.58-0.71 compared with monotherapy of other classes).
CCB-based AHM therapy was linked to a lower risk of probable AF events compared with non-CCB regimens in older adults who were initially free of CVD and AF and treated with any AHM. Additional studies are warranted to clarify the mechanisms underlying this association.
Details
- Title: Subtitle
- Anti-hypertensive Drug Classes and Risk of New-Onset Atrial Fibrillation in Healthy Older Adults: A Post Hoc Analysis of ASPREE Trial
- Creators
- Zhen Zhou - Monash UniversityMichelle A Fravel - University of IowaSuzanne G Orchard - Monash UniversityJoanne Ryan - Monash UniversitySophia Zoungas - Monash UniversitySharyn Fitzgerald - Monash UniversityAmy Brodtmann - Monash UniversityLawrence J Beilin - The University of Western AustraliaRory Wolfe - Monash UniversityAndrew M Tonkin - Monash UniversityMark R Nelson - University of TasmaniaRobyn L Woods - Monash UniversityNigel Stocks - The University of AdelaideChristopher M Reid - Curtin UniversityMichael E Ernst - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Drugs & aging, Vol.42(12), pp.1159-1167
- DOI
- 10.1007/s40266-025-01258-6
- PMID
- 41091441
- NLM abbreviation
- Drugs Aging
- ISSN
- 1170-229X
- eISSN
- 1179-1969
- Publisher
- Springer
- Language
- English
- Electronic publication date
- 10/15/2025
- Date published
- 12/2025
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science
- Record Identifier
- 9985016010902771
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