Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
Cardiovasc Ther. 2018 Dec;36(6):e12478. doi: 10.1111/1755-5922.12478. Epub 2018 Nov 28.
To investigate the upstream therapeutic effects of fluvastatin and valsartan on hypertensive patients with non-permanent atrial fibrillation (AF).
A total of 189 patients who were admitted to outpatient and inpatient department from eight medical centers in China, diagnosed as hypertension with non-permanent AF, were divided into four groups randomly: the CCBs group (group A, n = 45); CCB + fluvastatin group (group B, n = 48); valsartan group (group C, n = 46); valsartan + fluvastatin group (group D, n = 50). The four groups were followed up for 24 months. The blood routine, biochemical examination, echocardiography, high sensitive C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), the maintenance rate of sinus rhythm, and the recurrence of paroxysmal AF or persistent AF incidence were observed in these groups before and after 24 months' treatment.
After 24 months of follow-up, there were 178 cases of patients who have completed the study. (a) There was no significant difference in blood routine, liver, and renal function in each group (P > 0.05). (b) The blood lipids level in groups B and D was significantly reduced after treatment (P < 0.01). There was no significant difference of hs-CRP level in group A (P > 0.05). The left ventricular remodeling was significantly alleviated in group C and group D (P < 0.05). The NT-ProBNP level was significantly decreased in group D (P < 0.05). (c) The sinus rhythm maintenance rate of group B, group C, and group D was higher than group A (77.78%, 70.45%, 79.17% vs 43.90%), the occurrence of persistent AF was significantly lower than group A (11.11%, 14.29%, 8.33% vs 31.71%; P < 0.05).
CCB plus fluvastatin and valsartan can reduce the recurrence rate of non-permanent AF and to delay the progression from non-permanent AF to permanent AF in patients with hypertension. The combined application of valsartan and fluvastatin is more effective than valsartan or CCB alone in the upstream therapies of AF.
探讨氟伐他汀和缬沙坦对高血压伴非永久性心房颤动（AF）患者的上游治疗作用。
将 189 例因高血压伴非永久性 AF 于中国 8 家医学中心门诊和住院部就诊的患者随机分为 4 组：CCB 组（A 组，n=45）；CCB+氟伐他汀组（B 组，n=48）；缬沙坦组（C 组，n=46）；缬沙坦+氟伐他汀组（D 组，n=50）。4 组均随访 24 个月。观察治疗前及治疗 24 个月后各组血常规、生化检查、超声心动图、高敏 C 反应蛋白（hs-CRP）、N 末端脑钠肽前体（NT-proBNP）、窦性心律维持率及阵发性 AF 或持续性 AF 复发率。
随访 24 个月后，完成研究的患者有 178 例。（a）各组血常规、肝肾功能差异均无统计学意义（P>0.05）。（b）B 组和 D 组治疗后血脂水平明显降低（P<0.01）；A 组 hs-CRP 水平差异无统计学意义（P>0.05）；C 组和 D 组左心室重构明显改善（P<0.05）；D 组 NT-proBNP 水平明显降低（P<0.05）。（c）B 组、C 组和 D 组窦性心律维持率高于 A 组（77.78%、70.45%、79.17%比 43.90%），持续性 AF 发生率明显低于 A 组（11.11%、14.29%、8.33%比 31.71%）（P<0.05）。
CCB 联合氟伐他汀和缬沙坦可降低高血压伴非永久性 AF 患者的复发率，并延缓其从非永久性 AF 向永久性 AF 的进展。缬沙坦与氟伐他汀联合应用在 AF 的上游治疗中比缬沙坦或 CCB 单独应用更有效。
