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The renin-angiotensin-aldosterone system in atrial fibrillation: a new therapeutic target?

Journal of Human Hypertension volume 18, pages 461–465 (2004)Cite this article

Atrial fibrillation (AF) is the commonest sustained cardiac rhythm disorder, and leads to substantial mortality and morbidity from cardiovascular and cerebrovascular events. In addition, AF commonly coexists with other common cardiovascular disorders such as hypertension, heart failure and atherosclerotic vascular disease, and the presence of AF is additive to the vascular risk associated with these disorders. There is now mounting evidence that the renin-angiotensin-aldosterone system (RAAS) is implicated in this increased cardiovascular risk and that its blockade is beneficial.

Blocking the RAAS has been found to be useful in several cardiovascular disorders, such as hypertension, heart failure and possibly, atherosclerotic vascular disease. For example, the Heart Outcomes Prevention Evaluation (HOPE) study showed benefits of angiotensin-converting enzyme (ACE) inhibition in terms of cardiovascular outcome in patients with cardiovascular risk factors, but without left ventricular dysfunction.1 A further analysis of the HOPE trial also showed a reduction in stroke among those randomised to receive the ACE inhibitor ramipril. In addition, many trials have firmly established the value of ACE inhibitors in heart failure2 and the Assessment of Treatment with Lisinopril and Survival (ATLAS) trial confirmed the benefits of using high-dose over low-dose lisinopril in patients with heart failure.3 More recently, large megatrials such as the Losartan Intervention for Endpoint reduction in hypertension (LIFE) trial showed a substantial 25% reduction in stroke rates in those patients treated with the angiotensin receptor blocker (ARB) losartan, when compared with those on atenolol for hypertensive control.4

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  1. University Department of Medicine, Haemostasis, Thrombosis, and Vascular Biology Unit, City Hospital, Birmingham, England, UK

    B Freestone, D G Beevers & G Y H Lip

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  1. B Freestone
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  2. D G Beevers
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Correspondence to G Y H Lip.

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Freestone, B., Beevers, D. & Lip, G. The renin-angiotensin-aldosterone system in atrial fibrillation: a new therapeutic target?. J Hum Hypertens 18, 461–465 (2004). https://doi.org/10.1038/sj.jhh.1001694

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