The Double Sequential Actions of the Angiotensin II Receptor Blockers and Mineralocorticoid Receptor Antagonists Therapy on the Renin Angiotensin Aldosterone System Produce a Better Reduction of Both Blood Pressure and Central Haemodynamic Parameters and Can Prevent the Appearance of the Atrial Fibrillation

Abstract

Hypertension is a complex, multifactorial disease that has a significant positive association with adverse cardiovascular outcomes, such as myocardial infarction, stroke, kidney disease, and death. Research studies on hypertension have, so far, generally focused on vascular resistance and small arteries. The development of hypertension is usually accompanied by arterial structural remodelling, such as large artery stiffness, and increased both central systolic blood pressure and pulse pressure. Also, is well-established that hypertension is an important risk factor for atrial fibrillation. The goal of antihypertensive therapy is to prevent cardiovascular complications. Therefore, treatment with combination of antihypertensive agents acting on multiple targets is necessary for successful in the majority of patients. New therapeutics models are necessary to reduce both arterial stiffness and volume cardiovascular to ameliorate the stress of the arterial-ventricular-atrial dynamic coupling and the abnormal pulsatile system. The objective of the study was to assess the levels reached on both the systolic and diastolic blood pressure, and the central haemodynamic parameters into each one of the three groups of patients during the angiotensin II receptor blockers therapy alone, associated with hydrochlorothiazide or mineralocorticoid receptor antagonists, and observing the presence of episodes of atrial fibrillation during 24-hour Holter monitoring. The results suggest that the latter association of sequential double blockade on the renin angiotensin aldosterone system achieves the best haemodynamic conditions to avoid or reduce the presence of brief phases of atrial fibrillation on hypertensive patients with normal kidney function.