Horio T, Akiyama M, Iwashima Y, Yoshihara F, Nakamura S, Tokudome T, Okutsu M, Tanaka H, Komatsubara I, Okimoto N, Kamakura S, Kawano Y
Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
Division of Hypertension and Nephrology, Department of Lifestyle-related Diseases, National Cerebral and Cardiovascular Center, Suita, Japan.
J Hum Hypertens. 2017 Jul;31(7):450-456. doi: 10.1038/jhh.2016.95. Epub 2016 Dec 29.
It is still controversial whether treatment with renin-angiotensin system (RAS) inhibitors reduces the risk of incident atrial fibrillation (AF). This longitudinal observational study was performed to investigate the confounder-independent effects of RAS inhibitors on new-onset AF in hypertensive patients. Among 1263 consecutive hypertensive patients who underwent echocardiography, 964 eligible patients (mean age, 63 years) were enrolled as the study population. Forty-nine patients developed new-onset AF during the follow-up period (mean: 4.6 years). Kaplan-Meier analysis showed that the cumulative AF event rate was lower in patients receiving RAS inhibitors than in patients without these drugs, but the difference between these two groups was not significant (P=0.057). Since the use of RAS inhibitors was influenced by concomitant diabetes, chronic kidney disease and left ventricular hypertrophy, propensity score matching (1:1) was employed to minimize the influence of selection bias for RAS inhibitors. Clinical and echocardiographic parameters showed no significant differences between the propensity score-matched groups with and without RAS inhibitor therapy (both n=326), but the cumulative AF event rate was significantly lower in the group receiving RAS inhibitors (P=0.013). Univariate and multivariate Cox regression analyses also revealed that RAS inhibitor therapy was associated with a significantly lower risk of new-onset AF during the follow-up period. In conclusion, this propensity score matching study demonstrated that the incidence of new-onset AF was lower in hypertensive patients receiving RAS inhibitor therapy.
肾素-血管紧张素系统（RAS）抑制剂治疗是否能降低房颤（AF）发病风险仍存在争议。本纵向观察性研究旨在探讨RAS抑制剂对高血压患者新发房颤的独立于混杂因素的影响。在1263例连续接受超声心动图检查的高血压患者中，964例符合条件的患者（平均年龄63岁）被纳入研究人群。49例患者在随访期间（平均4.6年）发生新发房颤。Kaplan-Meier分析显示，接受RAS抑制剂治疗的患者累积房颤事件发生率低于未使用这些药物的患者，但两组之间的差异无统计学意义（P=0.057）。由于RAS抑制剂的使用受合并糖尿病、慢性肾脏病和左心室肥厚的影响，因此采用倾向评分匹配（1:1）以尽量减少RAS抑制剂选择偏倚的影响。临床和超声心动图参数在接受和未接受RAS抑制剂治疗的倾向评分匹配组之间无显著差异（两组均n=326），但接受RAS抑制剂治疗组的累积房颤事件发生率显著较低（P=0.013）。单因素和多因素Cox回归分析还显示，RAS抑制剂治疗与随访期间新发房颤风险显著降低相关。总之，这项倾向评分匹配研究表明，接受RAS抑制剂治疗的高血压患者新发房颤的发生率较低。
