Angiotensin converting enzyme inhibitor and angiotensin receptor blockade use in relation to outcomes in anticoagulated patients with atrial fibrillation.

Abstract

BACKGROUND:

The renin-angiotensin-aldosterone-system (RAAS) plays an important role in atrial fibrillation (AF). Evidence shows that blocking the RAAS with angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) has a definite role in preventing new onset AF and in maintaining sinus rhythm in recurrent AF. Our aim was to determine if ACEI/ARB treatment was associated with clinical outcomes [stroke/systemic embolic events (SEE), mortality] in a controlled, anticoagulated AF population.

METHODS:

An ancillary retrospective cross-sectional and longitudinal analysis of participants in the Stroke Prevention using an ORal Thrombin Inhibitor in AF (SPORTIF) III and V trials, in relation to use (or nonuse) of ACEI/ARBs.

RESULTS:

Rates of stroke/SEEs, mortality or major bleeding were no different between users and nonusers in the whole cohort, or in relation to the presence/absence of hypertension, coronary artery disease and previous stroke/transient ischaemic attack, nor amongst those aged <75 years. Patients aged > or = 75 years taking ACEIs or ARBs had lower mortality (HR 0.71, 95% CI 0.52-0.95), but no significant influence on other end-points was noted. Diabetics and those with left ventricular dysfunction on ximelagatran had a higher odds ratio of abnormal liver enzyme levels. There was no apparent benefit of ACEIs or ARBs on other event rates.

CONCLUSIONS:

This analysis from two large randomized trials of anticoagulation has not demonstrated a significant benefit of ACEI or ARB use amongst AF patients, except amongst elderly subjects.

• Authors: G Y H Lip, L Frison, M Grind
• Journal: Journal of internal medicine (J Intern Med) Vol. 261 Issue 6 Pg. 577-86 (Jun 2007) ISSN: 0954-6820 [Print] England
• PMID: 17547713 (Publication Type: Journal Article)

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Anticoagulants

Topics

• Aged
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (drug therapy)
• Drug Therapy, Combination
• Female
• Humans
• Male
• Middle Aged
• Proportional Hazards Models
• Randomized Controlled Trials as Topic
• Risk Factors
• Stroke (prevention & control)
• Treatment Outcome