title: Combined hypotensive treatment with ≥ 3 hypotensive drugs in patients with recurrent atrial fibrillation and arterial hypertension ensures more effective arrhythmia control than using less drugs.
abstract: BACKGROUND
  Combined arterial hypertension (AH) therapy ensures the effectiveness of treatment and improves haemodynamic parameters of cardiac function.
  
  
  OBJECTIVE
  The evaluation of therapeutic regimens in the prevention of recurrence of atrial fibrillation (AF) episodes in hypertensive patients with paroxysmal/persistent forms of AF.
  
  
  METHODS
  Prospective observation included patients (n = 164), without and with AH, grade I and II, with paroxysmal (51.3%) or persistent (48.7%) recurrent form of arrhythmia. Mean duration of AF was 4.0 years, (Q1:2; Q3:7). The anti-arrhythmic drugs were ineffective in prevention of AF episodes or non tolerated and were not used. In all patients precise control of blood pressure (BP) was implemented: patients were treated with beta-blockers: 100%; ACE-I: 65%, spironolactone: 47%, thiazide diuretics: 34%, loop-diuretics: 7%, calcium antagonists: 26.5% and alpha-blockers: 14.5%. Evaluation of symptomatic and confirmed AF episodes was performed every 3 months during 1-year follow-up.
  
  
  RESULTS
  AH, grade I and II, was diagnosed in 115, 75%, of patients; (74% men, mean age 65.5 ± 9.7 years). Persistent form of arrhythmia was more frequent in patients with AH: 83% in comparison with patients without AH: 67% (p 〈 0.05). BP values were similar in normotensive and hypertensive patients after completing the study: 123 ± 9/79 ± 4 vs. 124 ± 10/80 ± 0.5 mm Hg. One hypotensive drug was used in 6 patients, 2 drugs in 38 patients, 3 in 37, 4 in 27, 5 in 7. Patients treated with . 3 drugs had more AF episodes in 3 months prior to evaluation: 4.7 ± 0.8 vs. 2.9 ± 0.4, p = 0.0444. But during 1-year follow-up, observed in 3-months periods, they had significant reduction in every 3-months period, p = 0.0001. Patients treated with 1.2 drugs had significant reduction after 3 months: p = 0.0029, 6 months: p = 0.04 and 12 months: p = 0.0012, but not after 9 months.
  
  
  CONCLUSIONS
  AH promotes more advanced AF forms occurrence. Combined hypotensive therapy with minimum 3 drugs, including RAA inhibitors, may be effective in terms of BP control and reduction of arrhythmia episodes.
authors: 2nd Ischaemic Heart Disease Department, Institute of Cardiology, Warsaw, Poland.
authors: Ilona
authors: I
authors: Kowalik
authors: Rafał
authors: R
authors: Dąbrowski
authors: Anna
authors: A
authors: Borowiec
authors: Edyta
authors: E
authors: Smolis Bąk
authors: Cezary
authors: C
authors: Sosnowski
authors: Hanna
authors: H
authors: Szwed
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D004232:Diuretics / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D011446:Prospective Studies; D055502:Secondary Prevention; D013148:Spironolactone / Q000008:administration & dosage
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D013148:Spironolactone