Abstract 9533: Effect of Combined Ramipril-Canrenone on Atrial Fibrillation Recurrence in Hypertensive Patients With a History of Paroxysmal Atrial Fibrillation
Introduction: Angiotensin II and Aldosterone are key factors responsible for structural and electrical atrial remodelling in patients with atrial fibrillation (AF).
Hypothesis: Aim of this study was to evaluate the effect of ramipril/hydrochlorothiazide (HCTZ) combination (R/H) vs ramipril/canrenone (R/C) combination on symptomatic AF episode recurrence documented on the electrocardiogram (ECG) in hypertensive patients in sinus rhythm but with at least 2 episodes of AF in the previous 6 months. Canrenone is a derivative active metabolite of spiranolattone with lower antiandrogen activity.
Methods: a cohort of 195 consecutive hypertensive out-patients (aged 67 years, 103 men) were randomized to R/H or R/C for 1 year. Clinic blood pressure (BP) and 24-h ECG were evaluated monthly. Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible. P wave dispersion (PWD) and procollagen type I carboxy-terminal peptide (PIP) were evaluated before and after 12 month of treatment.
Results: SBP and DBP were similarly and significantly reduced by both treatments (p<0.001). In all 29.6% of patients treated with R/H had a recurrence of AF as did 11.7% of patients with R/C (p<0.01). PWD was significantly reduced by R/H (-4.6 ms p<0.05) and even more by R/C (-12.1 ms p<0.01 vs baseline, p<0.05 vs R/H). R/H reduced PIP (-42.1 μg/L p<0.05) but the reduction induced by R/C was significantly greater (-57.8 μg/L p<0.01).
Conclusions: These findings suggest that in these patients R/C combination is more effective than R/H combination in reducing AF recurrence as well as in improving PWD and cardiac fibrosis despite a similar BP reduction. This data outline the importance of aldosterone receptor blockade in prevention of AF recurrence.
Author Disclosures: R. Fogari: None. A. Mugellini: None. G. Derosa: None. M. Destro: None. A. Zoppi: None. P. Lazzari: None.
- © 2014 by American Heart Association, Inc.