Background:
Current evidence suggests that angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB) reduce the incidence of new atrial fibrillation (AF) in a variety of settings including the treatment of left ventricular dysfunction or hypertension. This study was to assess whether ACEIs and ARB could decrease incidence of AF in patients of end stage renal disease (ESRD).
Materials and Methods:
We identified all patients who developed ESRD through January 1998 to December 2008 from the National Health Insurance Research Database, Taiwan. The primary endpoint was new onset of AF and the median duration of follow up was 1499 days. The control group was patients not prescribing ACEIs or ARB. Hazard ration of both ACEIs vs. control and ARB vs. control were analyzed.
Results:
Among 102688 patients, 14926 (14.5%) were prescribed with ACEIs, 16282 (15.9) with ARB but 71480 (69.6%) were not prescribed ACEIs or ARB. Overall, patients treated with ACEIs (adjusted hazard ratio [HR] 0.587, 95% confidence interval [CI] 0.519-0.633, P<0.001 ) or ARB (adjusted HR 0.542, 95% CI 0.461-0.637, P<0.001 ) had a reduced incidence of AF. The preventive effect between two classes of drugs was favored ARB (P<0.001). The longer patients taking ACEIs or ARB, the better prevention of AF are. The similar reduction of AF is also noted in stratified analysis of age, gender, hypertension, congestive heart failure and diabetes.
Conclusion:
Both ACEIs and ARB appear to be effective in the primary prevention of AF in ESRD patients. This analysis supports the concept of renin-angiotensin system inhibition as an emerging treatment for the primary prevention of AF.
Angiotensin Receptor Blockers Decrease the Risk of Major Adverse Cardiovascular Events in Patients with End-Stage Renal Disease on Maintenance Dialysis: A Nationwide Matched-Cohort Study
