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Published on: February 26, 2013
Meta-analysis of renin angiotensin aldosterone modulators mitigating atrial fibrillation risk in hypertensive
Arankesh Mahadevan1, Sushmitha Garikipati2, Samir Vanani3
1SRM Medical College Hospital and Research Center, Chennai, India.
Insights
Angiotensin Converting Enzyme Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) significantly reduce the risk of new and recurring Atrial Fibrillation (AF) in hypertensive patients. These findings highlight the importance of using these medications for hypertension management.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Hypertension is linked to left ventricular hypertrophy and atrial ectopic rhythm, increasing Atrial Fibrillation (AF) risk.
- The impact of ACE inhibitors (ACEi) and ARBs on AF risk in hypertensive individuals requires stratification.
Purpose of the Study:
- To evaluate the effect of ACEi and ARBs on the incidence and recurrence of AF in patients with hypertension.
Main Methods:
- A systematic literature search was conducted across PubMed, Scopus, and Google Scholar.
- 19 studies involving 153,559 hypertensive patients were included.
- Meta-analysis using random-effects models and sensitivity analysis (leave-one-out) were performed.
Main Results:
- Both ACEi and ARBs significantly reduced the risk of incidental AF (adjusted OR 0.76, 95% CI [0.62-0.93]).
- For recurrent AF, adjusted analysis also showed a significant risk reduction (OR 0.62, 95% CI [0.50-0.76]).
- Sensitivity analyses confirmed the robustness of these findings.
Conclusions:
- ACEi and ARBs substantially decrease the risk of both incidental and recurrent AF in hypertensive patients.
- These findings underscore the critical role of ACEi and ARBs in managing hypertension and preventing AF.
Introduction:
Hypertension is associated with left ventricular hypertrophy/enlargement/fibrosis and atrial ectopic rhythm, leading to an increased risk of Atrial Fibrillation (AF). We aimed to stratify the effect of Angiotensin Converting Enzyme Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) on the risk of AF.
Methods:
PubMed, Scopus, and Google Scholar databases were screened, and cross-citation was conducted for studies reporting AF in hypertensive patients on ACEi and ARB. Of 145 studies found till May 2023, 19 were included in this study. Binary random-effects models estimated the pooled odds ratios, I2 statistics assessed heterogeneity and sensitivity analysis was assessed using the leave-one-out method.
Results:
153,559 hypertensive patients met the inclusion criteria. For incidental AF, ACEi and ARB showed a significant decrease in both unadjusted (OR 0.75, 95% CI [0.66-0.85], I² = 20.79%, p=0.29) and adjusted risks (OR 0.76, 95% CI [0.62-0.93], I² = 88.41%, p<0.01). In recurrent AF, the unadjusted analysis showed no significant effect (OR 0.89, 95% CI [0.55-1.42], I² = 78.44%, p<0.01), while the adjusted analysis indicated a reduced risk (OR 0.62, 95% CI [0.50-0.76], I² = 65.71%, p<0.01). Leave-one-out sensitivity analysis confirmed these results.
Conclusions:
ACEi and ARB considerably decrease the risk of incidental and recurrent AF in hypertensive patients, emphasizing the importance of treating clinical hypertension with these drugs.
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