Age and CHADS2 Score Predict the Effectiveness of Renin-Angiotensin System Blockers on Primary Prevention of Atrial Fibrillation
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Key result
RAS blockers linked to ~36% lower risk of new-onset AF versus other antihypertensives.
- HR 0.64
- 95% CI 0.58-0.71
- P<0.001
- n=22,324
Why the study?
Do renin-angiotensin system blockers prevent new-onset atrial fibrillation in hypertensive patients aged ≥ 45 years?
Population
22,324 propensity-score matched patients aged ≥ 45 years with hypertension from the Taiwan National Health…
Comparison
Renin-angiotensin system (RAS) blockers vs Non-users of RAS blockers
Design
Cohort
Follow-up
up to 10 years
Authors
Discussion
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Implication
May support RAS blocker preference to lower new-onset AF risk in hypertension; leaves open causality pending RCTs.
Study Design
Type
Cohort (n=22,324)
Structured PICO
Do renin-angiotensin system blockers prevent new-onset atrial fibrillation in hypertensive patients aged ≥ 45 years?
P
Population
22,324 hypertensive patients aged 45 years and older, free of prior atrial fibrillation, followed for up to 10 years.
E
Exposure
Renin-angiotensin system (RAS) blockers
C
Comparator
Non-users of RAS blockers
O
Outcome
New-onset atrial fibrillation (AF)hard clinical
Main Result
Hazard Ratio: 0.64 (95% CI 0.58–0.71)
Absolute Event Rate: 7.2% vs 9.6%
p-value: p=<0.001
RAS blockers significantly reduce the risk of new-onset atrial fibrillation in hypertensive patients, particularly those aged ≥ 55 years or with a CHADS2 score of 1 to 3.
Limitations
- Study population mainly included Asian subjects.
- Types of AF and duration of each AF episode were not included in the database.
- AF event definition may be under-reported as silent AF was not captured.
- Several confounding factors, including smoking, body mass index, and alcohol intake, were not included.
- No information on actual blood pressure control or whether the administered dose resulted in the target blood pressure.
- Assumed that patients took all prescribed medications, which may overestimate the actual dosage used.
Cite This Study
Hung et al. (2015) conducted a cohort in Hypertension (n=22,324). Renin-angiotensin system (RAS) blockers vs. Other antihypertensives was evaluated on New-onset atrial fibrillation (HR 0.64, 95% CI 0.58-0.71, p=<0.001). Renin-angiotensin system blockers reduced the risk of new-onset atrial fibrillation by 36% (HR 0.64) compared to other antihypertensives in patients with hypertension.
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