Fogari Roberto, Derosa Giuseppe, Ferrari Ilaria, Corradi Luca, Zoppi Annalisa, Lazzari Pierangelo, Santoro Tara, Preti Paola, Mugellini Amedeo
Department of Internal Medicine and Therapeutics, Centro per l'Ipertensione e la Fisiopatologia Cardiovascolare, University of Pavia, Pavia, Italy.
Am J Hypertens. 2008 Sep;21(9):1034-9. doi: 10.1038/ajh.2008.217. Epub 2008 Jun 19.
This study compared the effect of antihypertensive treatment with valsartan or ramipril on atrial fibrillation (AF) recurrence, on P-wave dispersion, (PWD) and on serum procollagen type I carboxy terminal peptide (PIP).
A total of 369 mild hypertensive (systolic blood pressure (SBP) >140 and/or 90 < diastolic blood pressure (DBP) < 110 mm Hg) outpatients in sinus rhythm but with at least two episodes of AF in the previous 6 months were randomized to valsartan (n = 122), ramipril (n = 124), or amlodipine (n = 123) for 1 year. Clinic blood pressure (BP) and a 24-h electrocardiogram (ECG) were evaluated monthly. Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible. PWD and serum PIP levels were evaluated before and after each treatment period.
SBP and DBP were significantly reduced by the three treatments (P < 0.001). A total of 46 (47.4%) patients treated with amlodipine had a recurrence of AF as did 26 (27.9%) patients treated with ramipril (P < 0.01 vs. amlodipine) and 16 (16.1%) patients treated with valsartan (P < 0.01 vs. amlodipine and P < 0.05 vs. ramipril). The Kaplan-Meyer analysis showed a significant reduction of AF episodes in the valsartan group (P = 0.005 log-rank test) as well as in the ramipril group (P = 0.021), even if at a lesser degree. PWD values were significantly reduced by ramipril (-4.2 ms, P < 0.05) and even more by valsartan (-11.2 ms, P < 0.01), the difference being significant (P < 0.01). Serum PIP levels were reduced by ramipril (-49.7 microg, P < 0.001) and valsartan (-49.3 microg, P < 0.001).
Despite similar BP lowering, valsartan and ramipril were more effective than amlodipine in preventing new episodes of AF, but the effect of valsartan was greater than that of ramipril. This could be related to the greater PWD reduction observed with valsartan.
本研究比较了缬沙坦或雷米普利降压治疗对心房颤动（AF）复发、P波离散度（PWD）及血清I型前胶原羧基末端肽（PIP）的影响。
共有369例轻度高血压（收缩压（SBP）>140和/或舒张压（DBP）90<110mmHg）且处于窦性心律但在过去6个月内至少有两次AF发作的门诊患者，被随机分为缬沙坦组（n = 122）、雷米普利组（n = 124）或氨氯地平组（n = 123），治疗1年。每月评估诊室血压（BP）和24小时心电图（ECG）。要求患者报告任何有症状的AF发作，并尽早进行ECG检查。在每个治疗阶段前后评估PWD和血清PIP水平。
三种治疗方法均使SBP和DBP显著降低（P<0.001）。共有46例（47.4%）接受氨氯地平治疗的患者发生AF复发，接受雷米普利治疗的患者中有26例（27.9%）（与氨氯地平相比，P<0.01），接受缬沙坦治疗的患者中有16例（16.1%）（与氨氯地平相比，P<0.01；与雷米普利相比，P<0.05）。 Kaplan - Meyer分析显示，缬沙坦组（P = 0.005，对数秩检验）和雷米普利组（P = 0.021）的AF发作次数均显著减少，尽管程度较轻。雷米普利使PWD值显著降低（-4.2ms，P<0.05），缬沙坦降低得更多（-11.2ms，P<0.01），差异有统计学意义（P<0.01）。雷米普利（-49.7μg，P<0.001）和缬沙坦（-49.3μg，P<0.001）均使血清PIP水平降低。
尽管降压效果相似，但缬沙坦和雷米普利在预防AF新发作方面比氨氯地平更有效，且缬沙坦的效果大于雷米普利。这可能与缬沙坦观察到的更大程度的PWD降低有关。
