The Benefit of Added Ranolazine to the Association of Angiotensin Receptor Blockers and Mineralocorticoid Receptor Antagonists Therapy for Ventricular Extrasystoles Treatment without the Use of Anti-Arrhythmic Drugs

Hypertension is a complex, multifactorial disease that has a significant positive association with adverse cardiovascular outcomes. The development of hypertension is usually accompanied by wall arterial structural remodelling, such as large artery stiffness, and increased central systolic blood pressure and pulse pressure. Also, is well established that hypertension is an important risk factor for ventricular extrasystoles. The goal of antihypertensive therapy is to prevent cardiovascular complications. Therefore, treatment with a combination of antihypertensive agents acting on multiple targets is necessary for success in the majority of patients. New therapeutics models are necessary to reduce both arterial stiffness and cardiovascular volume to ameliorate the stress of the arterial-ventricular-atrial dynamic coupling and the abnormal function of the pulsatile system. The objective of the study was to assess if the levels reached on both systolic and diastolic blood pressure, and the central haemodynamic parameters during the angiotensin II receptor blockers, mineralocorticoid receptor antagonists, and ranolazine therapy could avoid or diminish the presence of ventricular extrasystoles during 24- hour Holter monitoring. The results suggest that the association of simultaneous and sequential double blockade on the renin-angiotensin aldosterone system plus ranolazine therapy achieves the best haemodynamic conditions to avoid or reduce the presence of ventricular extrasystoles in hypertensive patients with normal kidney function.