Bosone Daniele, Costa Alfredo, Ghiotto Natascia, Ramusino Matteo Cotta, Zoppi Annalisa, D'Angelo Angela, Fogari Roberto
Interinstitutional Center of Neurological Medicine, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.
Department of Neurosciences and Behaviour, University of Pavia, Pavia, Italy.
Arch Med Sci. 2017 Apr 1;13(3):550-557. doi: 10.5114/aoms.2016.62448. Epub 2016 Sep 22.
The aim of this study was to compare the effect of ramipril/canrenone versus ramipril/hydrochlorothiazide (HCTZ) combination on atrial fibrillation (AF) recurrence in type 2 diabetic hypertensives with and without cardiac autonomic neuropathy (CAN).
A total of 289 hypertensive type 2 diabetic patients, 95 with CAN, in sinus rhythm but with at least two episodes of AF in the previous 6 months were randomized to ramipril 5 mg plus canrenone 50 mg (titrated to 10/100 mg) or to ramipril 5 mg plus HCTZ 12.5 mg (titrated to 10/25 mg) or to amlodipine 5 mg (titrated to 10 mg) for 1 year. Clinic blood pressure (BP) and a 24-h ECG were evaluated monthly. Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible. Serum procollagen type I carboxy-terminal peptide (PIP) and carboxy-terminal telopeptide of collagen type I (CITP) were evaluated before and after each treatment period.
Blood pressure was similarly and significantly reduced by all treatments. A total of 51% of patients with amlodipine had a recurrence of AF, as did 31% of patients with ramipril/HCTZ ( < 0.05 vs. amlodipine) and 13% of patients with ramipril/canrenone ( < 0.01 vs. amlodipine and < 0.05 vs. ramipril/HCTZ). A similar trend was found in diabetic patients with CAN. Both combinations reduced PIP and increased CITP, but the effects of ramipril/canrenone were significantly more marked.
These findings suggest that in type 2 diabetic hypertensives, ramipril/canrenone treatment was more effective than ramipril/HCTZ in reducing AF recurrence. This could be related to the greater improvement in cardiac fibrosis.
本研究旨在比较雷米普利/坎利酮与雷米普利/氢氯噻嗪（HCTZ）联合用药对伴有或不伴有心脏自主神经病变（CAN）的2型糖尿病高血压患者房颤（AF）复发的影响。
共有289例高血压2型糖尿病患者，其中95例伴有CAN，处于窦性心律，但在过去6个月内至少有两次房颤发作，被随机分为雷米普利5毫克加坎利酮50毫克（滴定至10/100毫克）组、雷米普利5毫克加HCTZ 12.5毫克（滴定至10/25毫克）组或氨氯地平5毫克（滴定至10毫克）组，治疗1年。每月评估临床血压（BP）和24小时心电图。要求患者报告任何有症状的房颤发作，并尽早进行心电图检查。在每个治疗期前后评估血清I型前胶原羧基末端肽（PIP）和I型胶原羧基末端端肽（CITP）。
所有治疗均使血压同样显著降低。氨氯地平组共有51%的患者房颤复发，雷米普利/HCTZ组为31%（与氨氯地平组相比，P<0.05），雷米普利/坎利酮组为13%（与氨氯地平组相比，P<0.oo1；与雷米普利/HCTZ组相比，P<0.05）。在伴有CAN的糖尿病患者中也发现了类似趋势。两种联合用药均降低了PIP并增加了CITP，但雷米普利/坎利酮的作用明显更显著。
这些发现表明，在2型糖尿病高血压患者中，雷米普利/坎利酮治疗在降低房颤复发方面比雷米普利/HCTZ更有效。这可能与心脏纤维化的更大改善有关。
