Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
Eur Heart J. 2014 May;35(18):1205-14. doi: 10.1093/eurheartj/eht507. Epub 2013 Dec 17.
To examine the associations between antihypertensive treatment with angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs), β-blockers, diuretics, or calcium-antagonists, and risk of atrial fibrillation. We examined these associations using the entire Danish population from 1995 through 2010.
Excluding medication used in atrial fibrillation, we matched individuals on ACEi monotherapy 1:1 with individuals on β-blocker (n = 48 658), diuretic (n = 69 630), calcium-antagonist (n = 57 646), and ARB monotherapy (n = 20 158). Likewise, individuals on ARB monotherapy were matched 1:1 with individuals on β-blocker (n = 20 566), diuretic (n = 20 832), calcium-antagonist (n = 20 232), and ACEi monotherapy (n = 20 158). All were free of atrial fibrillation and of predisposing diseases like heart failure, ischaemic heart disease, diabetes mellitus, and hyperthyroidism at baseline and none received any other antihypertensive medication. We studied risk of atrial fibrillation, and used risk of stroke, influenced by lowering blood pressure rather than renin-angiotensin system blockade per se, as an indicator of the importance of blood pressure lowering per se. Hazard ratios of atrial fibrillation for ACEi and ARB monotherapy were 0.12 (95% CI: 0.10-0.15) and 0.10 (0.07-0.14) compared with β-blocker, 0.51 (0.44-0.59) and 0.43 (0.32-0.58) compared with diuretic, and 0.97 (0.81-1.16) and 0.78 (0.56-1.08) compared with calcium-antagonist monotherapy. Risk of stroke did not differ among the five antihypertensive medications.
Use of ACEis and ARBs compared with β-blockers and diuretics associates with a reduced risk of atrial fibrillation, but not stroke, within the limitations of a retrospective study reporting associations. This suggests that controlling activation of the renin-angiotensin system in addition to controlling blood pressure is associated with a reduced risk of atrial fibrillation.
研究血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）、β受体阻滞剂、利尿剂或钙拮抗剂降压治疗与心房颤动风险之间的关系。我们使用 1995 年至 2010 年期间丹麦全体人群的数据来研究这些相关性。
排除心房颤动治疗中使用的药物，我们将 ACEi 单药治疗的个体（n=48658）与β受体阻滞剂（n=69630）、利尿剂（n=69630）、钙拮抗剂（n=57646）和 ARB 单药治疗的个体（n=20158）进行 1:1 匹配。同样，ARB 单药治疗的个体与β受体阻滞剂（n=20566）、利尿剂（n=20832）、钙拮抗剂（n=20232）和 ACEi 单药治疗的个体（n=20158）进行 1:1 匹配。所有个体在基线时均无心房颤动且无心力衰竭、缺血性心脏病、糖尿病和甲状腺功能亢进等易患疾病，并且均未使用任何其他降压药物。我们研究了心房颤动的风险，并使用了降低血压的重要性（而不是肾素-血管紧张素系统阻断本身）来作为中风风险的指标。与β受体阻滞剂相比，ACEi 和 ARB 单药治疗的心房颤动风险比为 0.12（95%CI：0.10-0.15）和 0.10（0.07-0.14），与利尿剂相比，ACEi 和 ARB 单药治疗的心房颤动风险比为 0.51（0.44-0.59）和 0.43（0.32-0.58），与钙拮抗剂单药治疗相比，ACEi 和 ARB 单药治疗的心房颤动风险比为 0.97（0.81-1.16）和 0.78（0.56-1.08）。五种降压药物之间的中风风险无差异。
在回顾性研究报告相关性的局限性内，与β受体阻滞剂和利尿剂相比，ACEi 和 ARB 的使用与心房颤动风险降低相关，但与中风风险无关。这表明，除了控制血压外，控制肾素-血管紧张素系统的激活与心房颤动风险降低有关。
