Antihypertensive treatment and risk of atrial fibrillation: a nationwide study
| Autor: | Marianne Benn, Sarah C. W. Marott, Sune F. Nielsen, Børge G. Nordestgaard |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Denmark medicine.medical_treatment Adrenergic beta-Antagonists Angiotensin-Converting Enzyme Inhibitors Angiotensin Receptor Antagonists Risk Factors Internal medicine Diabetes mellitus Atrial Fibrillation medicine Humans cardiovascular diseases Diuretics Stroke Antihypertensive Agents Aged Retrospective Studies business.industry Incidence Hazard ratio Atrial fibrillation Retrospective cohort study Middle Aged Calcium Channel Blockers medicine.disease Blood pressure Heart failure Hypertension Cardiology Female Diuretic Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal. 35:1205-1214 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/eht507 |
| Popis: | Aims To examine the associations between antihypertensive treatment with angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs), β-blockers, diuretics, or calcium-antagonists, and risk of atrial fibrillation. We examined these associations using the entire Danish population from 1995 through 2010. Methods and results Excluding medication used in atrial fibrillation, we matched individuals on ACEi monotherapy 1:1 with individuals on β-blocker ( n = 48 658), diuretic ( n = 69 630), calcium-antagonist ( n = 57 646), and ARB monotherapy ( n = 20 158). Likewise, individuals on ARB monotherapy were matched 1:1 with individuals on β-blocker ( n = 20 566), diuretic ( n = 20 832), calcium-antagonist ( n = 20 232), and ACEi monotherapy ( n = 20 158). All were free of atrial fibrillation and of predisposing diseases like heart failure, ischaemic heart disease, diabetes mellitus, and hyperthyroidism at baseline and none received any other antihypertensive medication. We studied risk of atrial fibrillation, and used risk of stroke, influenced by lowering blood pressure rather than renin-angiotensin system blockade per se , as an indicator of the importance of blood pressure lowering per se . Hazard ratios of atrial fibrillation for ACEi and ARB monotherapy were 0.12 (95% CI: 0.10–0.15) and 0.10 (0.07–0.14) compared with β-blocker, 0.51 (0.44–0.59) and 0.43 (0.32–0.58) compared with diuretic, and 0.97 (0.81–1.16) and 0.78 (0.56–1.08) compared with calcium-antagonist monotherapy. Risk of stroke did not differ among the five antihypertensive medications. Conclusion Use of ACEis and ARBs compared with β-blockers and diuretics associates with a reduced risk of atrial fibrillation, but not stroke, within the limitations of a retrospective study reporting associations. This suggests that controlling activation of the renin-angiotensin system in addition to controlling blood pressure is associated with a reduced risk of atrial fibrillation. |
| Databáze: | OpenAIRE |
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