Hypertension and atrial fibrillation

BASEL, SWITZERLAND. Patients with hypertension (elevated blood pressure) are usually treated with beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), or calcium channel blockers, sometimes accompanied by diuretics. Some studies suggest that drugs which interfere with the renin-angiotensin system may be favorable because of their beneficial affect on atrial remodeling. A group of researchers from the Basel University Hospital and Boston University Medical Center has just completed a study to determine if some anti-hypertensive drugs are better than others in preventing the development of atrial fibrillation among patients with hypertension.

Their study included 4,661 patients with AF and 18,642 matched controls all derived from a total population of 682,993 patients with elevated blood pressure, but no history of arrhythmias, ischemic heart disease or congestive heart failure. Almost two-thirds of the case patients were 70 years or older when they received their initial afib diagnosis and 47% were men. Obese patients with hypertension had a 71% greater risk of being diagnosed with AF.

Using treatment with calcium channel blockers as the reference point, the researchers observed that patients receiving beta-blockers had a 22% reduced risk of developing AF, those on ACE inhibitors a 25% reduced risk, and those on ARBs a 29% reduced risk. The researchers conclude that exclusive therapy with ACE inhibitors, ARBs, or beta-blockers reduces the risk for AF compared with calcium channel blocker therapy in patients with mild to moderate hypertension (those whose hypertension can be controlled with just one drug).

Schaer, BA, et al. Risk for incident atrial fibrillation in patients who receive antihypertensive drugs. Annals of Internal Medicine, Vol. 152, January 19, 2010, pp. 78-84

Editor’s comment: It would seem that treatment with an ARB such as valsartan (Diovan) or losartan (Cozaar) may be the best bet for patients with hypertension who wish to reduce their risk of developing afib. In this connection, it is of interest that ARBs have been found to reduce brain natriuretic peptide (BNP), a high level of which is strongly related to the risk of developing AF. In looking at the baseline characteristics of the study participants, it is of interest to note that over 40% suffered from depression, almost 90% had been on antibiotics, and close to 70% were overweight or obese – not a very healthy bunch!