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Preventive effect of renin-angiotensin system inhibitors on new-onset atrial fibrillation in hypertensive patients: a propensity score matching analysis

Journal of Human Hypertension volume 31, pages 450–456 (2017)Cite this article

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Abstract

It is still controversial whether treatment with renin-angiotensin system (RAS) inhibitors reduces the risk of incident atrial fibrillation (AF). This longitudinal observational study was performed to investigate the confounder-independent effects of RAS inhibitors on new-onset AF in hypertensive patients. Among 1263 consecutive hypertensive patients who underwent echocardiography, 964 eligible patients (mean age, 63 years) were enrolled as the study population. Forty-nine patients developed new-onset AF during the follow-up period (mean: 4.6 years). Kaplan–Meier analysis showed that the cumulative AF event rate was lower in patients receiving RAS inhibitors than in patients without these drugs, but the difference between these two groups was not significant (P=0.057). Since the use of RAS inhibitors was influenced by concomitant diabetes, chronic kidney disease and left ventricular hypertrophy, propensity score matching (1:1) was employed to minimize the influence of selection bias for RAS inhibitors. Clinical and echocardiographic parameters showed no significant differences between the propensity score-matched groups with and without RAS inhibitor therapy (both n=326), but the cumulative AF event rate was significantly lower in the group receiving RAS inhibitors (P=0.013). Univariate and multivariate Cox regression analyses also revealed that RAS inhibitor therapy was associated with a significantly lower risk of new-onset AF during the follow-up period. In conclusion, this propensity score matching study demonstrated that the incidence of new-onset AF was lower in hypertensive patients receiving RAS inhibitor therapy.

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Acknowledgements

The authors thank Yoko Saito, Naomi Fukushima, Seri Sugishita and Erina Osaki for their secretarial assistance. We also thank Shinji Maeda for his assistance with propensity score-matched analysis. This study was supported in part by a Grant-in-Aid (JP25461079, T. Horio) for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan and an Intramural Research Grant (22-1-2, S. Kamakura) for Cardiovascular Diseases of the National Cerebral and Cardiovascular Center, Japan.

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Authors and Affiliations

  1. Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan

    T Horio, M Akiyama, M Okutsu, H Tanaka, I Komatsubara & N Okimoto

  2. Division of Hypertension and Nephrology, Department of Lifestyle-related Diseases, National Cerebral and Cardiovascular Center, Suita, Japan

    Y Iwashima, F Yoshihara & S Nakamura

  3. Department of Biochemistry, Research Institute, National Cerebral and Cardiovascular Center, Suita, Japan

    T Tokudome

  4. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan

    S Kamakura

  5. Department of Medical Technology, Faculty of Fukuoka Medical Technology, Teikyo University, Omuta, Japan

    Y Kawano

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  1. T Horio
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  3. Y Iwashima
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Correspondence to T Horio.

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Horio, T., Akiyama, M., Iwashima, Y. et al. Preventive effect of renin-angiotensin system inhibitors on new-onset atrial fibrillation in hypertensive patients: a propensity score matching analysis. J Hum Hypertens 31, 450–456 (2017). https://doi.org/10.1038/jhh.2016.95

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