Can the Treatment of Hypertension Prevent Recurrence of Atrial Fibrillation?
Atrial fibrillation (Afib) is the most common serious heart rhythm disorder and is responsible for a significant portion of deaths in the population. Hypertension is the most common and potentially modifiable risk factor for Afib. A newly published meta-analysis compares the effect of angiotensin receptor antagonism and calcium channel blockade on Afib recurrence in patients with hypertension and Afib.
Impact of Antihypertensive Therapy on Afib
Treating hypertension can reduce the risk of Afib by reversing the structural damage to the heart caused by hypertension. Currently, first-line medications for hypertension treatment include angiotensin II receptor antagonists (ARBs; sartans) and calcium channel blockers (CCBs), but it is not entirely clear whether ARBs or CCBs are more effective in reversing structural changes in the heart muscle.
Analyzed Studies
A total of 7 clinical studies were analyzed, involving 1,495 patients with Afib and hypertension, aged between 55 and 75 years. All had experienced an episode of Afib confirmed by ECG in the last 6 months. The ARBs used included telmisartan, valsartan, losartan, irbesartan, and candesartan, while the CCBs included amlodipine and nifedipine. Two studies were conducted in China, two in Japan, and three in Italy.
Key Findings
The analysis indicated that ARBs are significantly superior to CCBs in preventing Afib recurrence (odds ratio [OR] 0.47; 95% confidence interval [CI] 0.30–0.72; p = 0.0006; I2 = 57.6%) and in preventing persistent Afib (OR 0.41; 95% CI 0.24–0.71; p = 0.001; I2 = 0%).
The authors further compared the subgroup treated with telmisartan to the other ARBs. In the telmisartan subgroup, no significant difference was found between ARBs and CCBs (OR 0.54; 95% CI 0.23–1.29; p = 0.17), but significant statistical heterogeneity was observed (p = 0.02; I2 = 80.0%). In the other subgroup, ARBs were significantly superior to CCBs in preventing Afib recurrence (OR 0.42; 95% CI 0.23–0.77; p = 0.005) with moderate heterogeneity (p = 0.129; I2 = 51.2%).
In the subgroup treated with nifedipine, no difference was noted between ARBs and CCBs (OR 0.88; 95% CI 0.46–1.68; p = 0.69). In the amlodipine subgroup, ARBs were significantly superior to CCBs in preventing Afib recurrence (OR 0.39; 95% CI 0.27–0.56; p < 0.0001) with moderate heterogeneity (p = 0.235; I2 = 29.5%).
Conclusion
The results of the recent meta-analysis suggest the superiority of sartans compared to calcium channel blockers in preventing the recurrence of atrial fibrillation and persistent Afib.
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Source: Ma H., Jiang H., Feng J. et al. Angiotensin receptor blocker and calcium channel blocker preventing atrial fibrillation recurrence in patients with hypertension and atrial fibrillation: a meta-analysis. Cardiovasc Ther 2021 May 17; 2021: 6628469, doi: 10.1155/2021/6628469.
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