DOI: 10.1097/01.hjh.0000379619.54743.b2
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Issn Print: 0263-6352
Publication Date: 2010/06/01
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Abstract
Introduction:Atrial fibrillation significantly increases risk of developing major cardiovascular (CV) events, mostly stroke, in hypertensive patients and worsens prognosis in patients with cardiac diseases or heart failure. Thus, new onset atrial fibrillation (NOAF) represents an adverse complication during long-term treatment of CV diseases. Randomised trials and meta-analyses suggested that Renin-Angiotensin System (RAS) blockers may significantly reduce NOAF.
Objective:To evaluate the efficacy of Angiotensin-Converting Enzime (ACE) Inhibitors and Angiotensin II Receptor Blockers (ARBs) in term of incidence of NOAF in international, randomised, controlled clinical trials.
Design and Method:We performed a comprehensive meta-analysis of all available clinical trials performed with ACE Inhibitors (SOLVD, TRACE, CAPPP, STOP2, GISSI-3) or ARBs (Val-HeFT, LIFE, VALUE, OPTIMAAL, CHARM, ONTARGET, TRANSCEND, PROFESS, GISSI-AF), published within December 31 2009 (14 trials, n = 108.722 patients, mean age 66.1 ± 5.3 years), which reported absolute incidence of NOAF, either as predefined CV endpoint or as drug-related adverse event, as compared to placebo or other active treatment strategies in different clinical conditions.
Results:During a mean follow-up of 3.8 ± 1.5 years, we recorded 1014/8520 cases in the ACE Inhibitorgroup, 1966/29945 cases in the ARB group and 3278/38385 cases in the placebo group. In the presence of heterogeneity among selected clinical trials, antihypertensive therapy based on ACE Inhibitors (OR 0,8998; 95% IC 0,7439–1,0884) or ARBs (OR 0,8820; 95% IC 0,7695–1,0109) significantly reduced NOAF incidence. In particular, this beneficial effect of RAS blocking agents has been observed in patients with coronary artery disease (OR 0,8906; 95% CI 0,8056–0,9845) or congestive heart failure (OR 0,7352; 95% IC 0,6299–0,8580), and seems to be independent by the comparator strategy (placebo, conventional or active treatment). Overall, Renin-Angiotensin System (RAS) blocking agents significantly reduced NOAF incidence (OR 0,8861; 95% IC 0,7980–0,9840) as compared to any other treatment strategy, including placebo.
Conclusions:The clinical use of RAS blocking agents significantly reduced NOAF incidence in clinical trials performed in high risk patients in different clinical settings.
