title: Preventive effect of renin-angiotensin system inhibitors on new-onset atrial fibrillation in hypertensive patients: a propensity score matching analysis.
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.
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Horio
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Akiyama
authors.affiliation: Division of Hypertension and Nephrology, Department of Lifestyle-related Diseases, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Iwashima
authors.affiliation: Division of Hypertension and Nephrology, Department of Lifestyle-related Diseases, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Yoshihara
authors.affiliation: Division of Hypertension and Nephrology, Department of Lifestyle-related Diseases, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Biochemistry, Research Institute, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tokudome
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Okutsu
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Komatsubara
authors.affiliation: Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Okimoto
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kamakura
authors.affiliation: Department of Medical Technology, Faculty of Fukuoka Medical Technology, Teikyo University, Omuta, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kawano
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors