Emergency Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China.
BMC Cardiovasc Disord. 2022 Apr 1;22(1):141. doi: 10.1186/s12872-022-02580-2.
Renin-angiotensin-aldosterone-system inhibitors markedly play an active role in the primary prevention of atrial fibrillation (AF), but the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on the mortality of patients with AF remains unclear. This study aimed to examine the relationship between treatment with ACEIs or ARBs and mortality in emergency department (ED) patients with AF and hypertension.
This multicenter study enrolled 2016 ED patients from September 2008 to April 2011; 1110 patients with AF and hypertension were analyzed. Patients were grouped according to whether they were treated with ACEI/ARB or not and completed a 1-year follow-up to evaluate outcomes including all-cause death, cardiovascular death, stroke, and major adverse events (MAEs).
Among the 1110 patients with AF and hypertension, 574 (51.7%) received ACEI/ARB treatment. During the 1-year follow-up, 169 all-cause deaths (15.2%) and 100 cardiovascular deaths (9.0%) occurred, while 98 strokes (8.8%) and 255 MAEs (23.0%) occurred. According to the multivariate Cox regression analysis, ACEI/ARB therapy was significantly associated with a reduced risk of all-cause death (HR, 0.605; 95% CI 0.431-0.849; P = 0.004). Moreover, ACEI/ARB therapy was independently associated with a reduced risk of cardiovascular death (HR 0.585; 95% CI 0.372-0.921; P = 0.020) and MAEs (HR 0.651, 95% CI 0.496-0.855, P = 0.002) after adjusting for other risk factors.
Our results revealed that ACEI/ARB therapy was independently associated with a reduced risk of all-cause death, cardiovascular death, and MAEs in ED patients with AF and hypertension. These results provide evidence for a tertiary preventive treatment for patients with AF and hypertension.
肾素-血管紧张素-醛固酮系统抑制剂在心房颤动（AF）的一级预防中发挥着重要作用，但血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）对 AF 患者死亡率的影响尚不清楚。本研究旨在探讨 ACEI 或 ARB 治疗与急诊（ED）AF 合并高血压患者死亡率之间的关系。
这是一项多中心研究，纳入了 2008 年 9 月至 2011 年 4 月期间的 2016 例 ED 患者；分析了 1110 例 AF 合并高血压患者。根据是否接受 ACEI/ARB 治疗将患者分为两组，并完成了为期 1 年的随访，以评估包括全因死亡、心血管死亡、卒中和主要不良事件（MAE）在内的结局。
在 1110 例 AF 合并高血压患者中，574 例（51.7%）接受 ACEI/ARB 治疗。在 1 年的随访期间，发生了 169 例全因死亡（15.2%）和 100 例心血管死亡（9.0%），发生了 98 例卒中和 255 例 MAE（23.0%）。根据多变量 Cox 回归分析，ACEI/ARB 治疗与全因死亡风险降低显著相关（HR，0.605；95%CI，0.431-0.849；P=0.004）。此外，ACEI/ARB 治疗与心血管死亡风险降低独立相关（HR，0.585；95%CI，0.372-0.921；P=0.020）和 MAE 风险降低独立相关（HR，0.651，95%CI，0.496-0.855，P=0.002），在调整其他危险因素后。
我们的研究结果表明，ACEI/ARB 治疗与 ED 中 AF 合并高血压患者的全因死亡、心血管死亡和 MAE 风险降低独立相关。这些结果为 AF 和高血压患者的三级预防治疗提供了证据。
