Fogari Roberto, Mugellini Amedeo, Destro Maurizio, Corradi Luca, Zoppi Annalisa, Fogari Elena, Rinaldi Andrea
Department of Internal Medicine and Therapeuthics, Clinica Medica II, IRCCS Policlinico S.Matteo, University of Pavia, Pavia, Italy.
J Cardiovasc Pharmacol. 2006 Jan;47(1):46-50. doi: 10.1097/01.fjc.0000193808.99773.28.
The aim of the study was to evaluate the effect of losartan as compared with amlodipine, both associated with amiodarone, in preventing the recurrence of atrial fibrillation (AF) in hypertensive patients with a history of recent paroxysmal atrial fibrillation. Two hundred and fifty mild hypertensive (SBP > 140 mm Hg and/or DBP > 90 < 100 mm Hg) outpatients in sinus rhythm but with at least two ECG-documented episodes of symptomatic atrial fibrillation in the previous 6 months and in treatment with amiodarone were randomized to losartan or amlodipine and were followed up for 1 year. Clinic blood pressure (BP) and a 24-hour ECG was evaluated every month; the patients were asked to report any episode of symptomatic atrial fibrillation and to perform an ECG as early as possible. Two hundred and thirteen patients completed the study, 107 in the losartan group and 106 in the amlodipine group. After 12 months the SBP/DBP mean values were significantly reduced by both losartan (from 151.4/95.6 to 135.5/83.7 mm Hg, P < 0.001 versus baseline) and amlodipine (from 152.3/96.5 to 135.2/83.4 mm Hg, P < 0.001 versus baseline), with no difference between the two treatments. At least one ECG-documented episode of atrial fibrillation was reported in 13% of the patients treated with losartan and in 39% of the patients treated with amlodipine. The use of losartan in combination with amiodarone seems more effective than amlodipine/amiodarone combination in preventing new episodes of atrial fibrillation in hypertensive patients with recurrent atrial fibrillation. This might be related to possible favorable impact of angiotensin II receptor blockers (ARB) on the atrial electrical and structural remodeling in this type of patients.
本研究旨在评估氯沙坦与氨氯地平相比，二者均联合胺碘酮，在预防近期有阵发性心房颤动病史的高血压患者心房颤动（AF）复发方面的效果。250例轻度高血压（收缩压>140 mmHg和/或舒张压>90<100 mmHg）且处于窦性心律，但在过去6个月内有至少两次心电图记录的症状性心房颤动发作且正在接受胺碘酮治疗的门诊患者，被随机分为氯沙坦组或氨氯地平组，并随访1年。每月评估临床血压（BP）和24小时心电图；要求患者报告任何症状性心房颤动发作，并尽早进行心电图检查。213例患者完成了研究，氯沙坦组107例，氨氯地平组106例。12个月后，氯沙坦（从151.4/95.6降至135.5/83.7 mmHg，与基线相比P<0.001）和氨氯地平（从152.3/96.5降至135.2/83.4 mmHg，与基线相比P<0.001）均使收缩压/舒张压平均值显著降低，两种治疗之间无差异。接受氯沙坦治疗的患者中有13%报告至少有一次心电图记录的心房颤动发作，接受氨氯地平治疗的患者中有39%报告有此类发作。在预防复发性心房颤动的高血压患者中，氯沙坦与胺碘酮联合使用似乎比氨氯地平/胺碘酮联合使用更有效地预防心房颤动新发作。这可能与血管紧张素II受体阻滞剂（ARB）对这类患者心房电重构和结构重构可能产生的有利影响有关。
