Abstract 14391: Reduced Incidence of New-Onset Atrial Fibrillation With Renin-Angiotensin System Inhibitors in Japanese Hypertensive Patients
Background: Several clinical trials have shown that inhibitors of the renin-angiotensin system (RAS), i.e., angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs), are associated with lower risk of incident atrial fibrillation (AF). In some recent studies, however, treatment with ARBs was not effective in reducing AF episodes in patients with paroxysmal AF or after cardioversion. Furthermore, limited data are available on whether AF incidence is affected by other classes of antihypertensive medications. This longitudinal observational study investigated the effect of RAS inhibitors and other classes of antihypertensive drugs on the new onset of AF in Japanese hypertensives.
Methods: A total of 1,022 essential hypertensive patients (mean age, 63 years) without previous paroxysmal AF, heart failure, myocardial infarction, or valvular disease were enrolled. At baseline, left atrial (LA) dimension and left ventricular mass index (LVMI) were determined in echocardiographic examinations.
Results: During follow-up periods (mean, 4.6 years), 51 cases of new-onset AF (including paroxysmal AF) were found. Cumulative AF event-free rates by the Kaplan-Meier method tended to be lower in patients treated with RAS inhibitors than those without the use of those agents (6.3% and 12.0%, log-rank test P=0.057). Since the incidence of AF was influenced by age, LA size, and LVMI, and the use of RAS inhibitors was related to concomitant diabetes mellitus or chronic kidney disease, the effects of antihypertensive agents on the occurrence of AF were evaluated after adjustment for various confounding factors by multivariate Cox regression analysis. As a result, the use of RAS inhibitors was independently associated with a decreased risk of new-onset AF (HR 0.51, P=0.022). Ca channel blockers (HR 1.18, P=0.728), beta-blockers (HR 0.86, P=0.627), or diuretics (HR1.04, P=0.910) did not significantly affect the incidence of AF.
Conclusions: The present study showed that treatment with RAS inhibitors was associated with a reduced incidence of new-onset AF in Japanese hypertensives. Therefore, RAS inhibitors may have a beneficial effect on the primary prevention of AF in hypertensive patients, but not on recurrent AF (secondary prevention).
- © 2011 by American Heart Association, Inc.