THE BENEFIT OF THERAPY USING RENIN-ANGIOTENSIN SYSTEM BLOCKERS IN PREVENTING RECURRENT ATRIAL FIBRILLATION IN HIGH RISK HYPERTENSIVE PATIENTS: PP.1.46

Abstract

Objective: To assess the benefit of therapy using angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in high risk hypertensive patients in decreasing atrial fibrillation recurrences. Methods: 112 hypertensive patients with other associated major CV risk factors (diabetes, smoking, dyslipidemia) were included. All of them had sinus rhythm at baseline, but have had medical records of atrial fibrillation (AF). The mean follow-up was 18 months. The demographic and biochemical data were recorded for each patient; TSH determination was routinely used to exclude thyroid dysfunction. Echocardiography was performed at baseline and after 18 months in order to assess left atrial (LA) volume and mitral inflow Doppler pattern. 24 h blood pressure (BP) monitoring was indicated in each case. ECG Holter was performed at 6, 12 and 18 mo for asymptomatic rhythm disorders detection. AF diagnosis was based on objective ECG recording for symptomatic patients and Holter ECG recording for asymptomatic patients. 62 patients received ACEI or ARB as initial antihypertensive therapy and a diuretic was added in cases of uncontrolled BP (group 1). The other 50 patients received a dihydropyridine calcium blocker, associated, when needed, with a beta-blocker (group 2). Results: There weren't significantly differences between the 2 groups concerning age (52 ± 7 vs. 54 ± 6 yrs), male gender (59,6% vs. 64%), diabetes incidence (45% vs. 44%), smoking (41,9% vs. 38%) and dyslipidemia (54,8% vs. 54%) (p ns). Echocardiographic evaluation, and BP monitoring results are shown in the table. After 18 mo of follow-up, atrial fibrillation was recorded in 9,7% patients from group 1 and 24% patients from group 2 (p 0,05). Conclusions: Renin-angiotensin system blockers therapy in high risk hypertensive patients decreases the risk of atrial fibrillation and its recurrences. The benefits of this therapy are based probably on decreasing BP and left ventricular mass index, improving diastolic dysfunction with positive changes on left atrial remodeling.