Preventive role of angiotensin receptor blockers on the recurrent AF in hypertensive patients

Type of funding sources: None.

The structural remodeling makes important contributions to the AF substrate. The formation of connective tissue in response to injury (cardiac fibrosis) is a hallmark of arrhythmogenic structural remodeling. The atrial fibrosis decrease can be helpful in preventing the onset and recurrence of AF. Inflammatory mechanisms may form a basis for new agents more likely to prevent recurrent episodes of AF. The renin-angiotensin-aldosterone system plays an important role in the pathogenesis of AF in correlation with the inflammatory process. The aim of this study is to access the role of long-term treatment by sartans on the regression of left heart remodeling and the frequency of AF recurrence after successful cardioversion in hypertensive patients.

We have follow up 119 hypertensive patients with paroxysmal / persistent AF after successful cardioversion during 10-12 months. All patients divided into two groups: group A (62 patients) treated by Losartan daily dose 50 -100 mg or Valsartan daily dose 160mg for 10-12 months. As a control group B of similar 57 patients received standard antihypertensive therapy, but without taking sartans. Both groups were received supporting antiarrhythmic therapy with Аmiodarone (200-300 mg daily). The patients underwent clinical examination, echocardiography, ECG Holter monitoring and determination of plasma levels of inflammatory and fibrosis markers - high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6) and profibrotic cytokine - transforming growth factor beta (TGF-β1) by ELIZA. Statistical analysis was performed by SPSS-16.

The obtained results have shown that it was no significant differences of the antihypertensive effect in both patients groups. But the obtained data of structural remodeling regression in A and B groups were differed significantly. Thus, in the A group decrease in LVTDV, TMZHP and LVEDD and an improvement in left ventricular diastolic function were revealed, on compared to the B group which showed only a tendency to improve these indicators. Moreover, in group A, there was a significant decrease in the concentration of inflammation and fibrosis markers compared with the control group. We obtained a positive correlation between hsCRP and LAD (r=0.58, p<0.001) and LVEDD (r=0.51, p<0.001), between TGF-β1 and LAD (r=0.55, p<0.001), LVEDD (r=0.59, p<0.001) and number of AF episodes (r=0.489, p<0.001.). The negative correlation was found between hsCRP and TGF-β1 (r=-0.36, p<0.01). It was revealed that in a group recurrence of AF was less than in B group (6.8% vs 10%).

These results confirmed that the use of angiotensin receptor blockers improves some cardiac remodeling parameters, decreases the frequency of AF recurrence in hypertensive patients with successful cardioversion and contributes to prevent AF episodes.