Jibrini Mhamad B, Molnar Janos, Arora Rohit R
Division of Cardiology, Department of Medicine, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Am J Ther. 2008 Jan-Feb;15(1):36-43. doi: 10.1097/MJT.0b013e31804beb59.
The renin-angiotensin-aldosterone system (RAAS) has emerged as an important hormonal system in the initiation and pathogenesis of atrial fibrillation (AF). Therefore, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are emerging as novel drugs for the prevention of AF. A meta-analysis of 11 randomized, controlled, parallel-design clinical trials evaluating effect of ACEIs or ARBs on the development of AF was performed. Treatment with ACEIs or ARBs reduced the relative risk (RR) of AF in patients with hypertension by 23% [RR 0.769, P < 0.001, 95% confidence interval (CI) 0.686-0.862] and by 11% in patients after myocardial infarction (RR 0.898, P < 0.05, 95% CI 0.814-0.992). Reduction in AF was greatest in patients after electrical cardioversion (RR 0.491, P < 0.001, 95% CI 0.334-0.720) and in patients with heart failure (RR 0.684, P < 0.001, 95% CI 0.594-0.787). Overall, inhibition of the RAAS reduced the RR of AF by 19% (RR 0.810, P < 0.001, 95% CI 0.759-0.865).
肾素-血管紧张素-醛固酮系统（RAAS）已成为心房颤动（AF）起始和发病机制中的一个重要激素系统。因此，血管紧张素转换酶抑制剂（ACEIs）或血管紧张素受体阻滞剂（ARBs）正成为预防AF的新型药物。对11项评估ACEIs或ARBs对AF发生影响的随机、对照、平行设计临床试验进行了荟萃分析。ACEIs或ARBs治疗使高血压患者发生AF的相对风险（RR）降低了23%[RR 0.769，P<0.001，95%置信区间（CI）0.686-0.862]，使心肌梗死后患者的RR降低了11%（RR 0.898，P<0.05，95%CI 0.814-0.992）。在电复律后的患者（RR 0.491，P<0.001，95%CI 0.334-0.720）和心力衰竭患者（RR 0.684，P<0.001，95%CI 0.594-0.787）中，AF的降低最为显著。总体而言，抑制RAAS使AF的RR降低了19%（RR 0.810，P<0.001，95%CI 0.759-0.865）。
