Regulatory and adaptive status: bisoprolol vs sotalol in co-existent hypertension and paroxysmal atrial fibrillation

Abstract

Background. Atrial fibrillation (AF) is associated with the increase in mortality from cardiovascular causes, systemic thromboembolism, congestive heart failure, high rate of hospitalization and deterioration of quality of life. Hypertension (HTN) is the most common cause of AF. Beta-blockers are the therapy of choice for AF prevention. To predict the therapy efficiency, one should assess the regulatory and adaptive status (RAS). The aim of our study was to compare bisoprolol vs sotalol in patients with HTn and paroxysmal AF taking into account quantitative indices of the regulatory adaptive status (RAS). Design and methods. We included 50 patients with HTN stages II–III and paroxysmal AF and randomized them into two groups for treatment with bisoprolol (6,4 ± 1,8 mg/day, n = 25) or sotalol (157,0 ± 38,3 mg/day, n = 25). As part of combination therapy, lisinopril (14,2 ± 3,8 and 14,0 ± 4,8 mg/day), atorvastatin (17,1 ± 3,7 mg/day, n = 11 and 16,0 ± 5,1 mg/day, n = 11), acetylsalicylic acid were prescribed (90,0 ± 14,6 mg/day, n = 12 and 92,1 ± 16,8 mg/day, n = 12), respectively. At baseline and 6 months after therapy, quantitative assessment of RAS (by cardio-respiratory synchronism test), echocardiography, triplex scanning of brachiocephalic arteries, treadmill test, six-minute walk test, 24‑hour blood pressure and electrocardiogram monitoring, subjective assessment of quality of life. Results. Both schemes comparably improved structural and functional parameters of the heart, increased exercise tolerance, controlled arterial hypertension, effectively suppressed AF paroxysms, improved quality of life. At the same time, sotalol led to the decrease of RAS to a lesser degree than bisoprolol. Conclusions . In patients with HTN stages II–III and paroxysmal AF sotalol as a component of the combination therapy may be preferable to bisoprolol due to its lower impact on the RAS.