Preventive effect of renin-angiotensin system inhibitors on new-onset atrial fibrillation in hypertensive patients: a propensity score matching analysis
Preventive effect of renin-angiotensin system inhibitors on new-onset atrial fibrillation in hypertensive patients: a propensity score matching analysis
复制标题
肾素-血管紧张素系统抑制剂对高血压患者新发房颤的预防作用：倾向评分匹配分析
DOI：
10.1038/jhh.2016.95
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发表时间：
2017
影响因子：
2.7
通讯作者：
Kawano Y
中科院分区：
文献类型：
--
作者：
Horio T;Akiyama M;Iwashima Y;Yoshihara F;Nakamura S;Tokudome T;Okutsu M;Tanaka H;Komatsubara I;Okimoto N;Kamakura S;Kawano Y
肾素血管紧张素系统（RAS）抑制剂治疗是否可以降低心房颤动（AF）的风险仍存在争议。这项纵向观察性研究的目的是调查 RAS 抑制剂对高血压患者新发 AF 的独立影响。在 1263 名连续接受超声心动图检查的高血压患者中，964 名符合条件的患者（平均年龄 63 岁）被纳入研究人群。 49 名患者在随访期间（平均：4.6 年）出现新发 AF。 Kaplan-Meier分析显示，接受RAS抑制剂治疗的患者的累积房颤事件发生率低于未接受这些药物治疗的患者，但这两组之间的差异并不显着（P=0.057）。由于RAS抑制剂的使用受到伴随糖尿病、慢性肾病和左心室肥大的影响，因此采用倾向评分匹配（1:1）来尽量减少RAS抑制剂选择偏倚的影响。临床和超声心动图参数显示，接受和不接受 RAS 抑制剂治疗的倾向评分匹配组（均为 n= 326）之间没有显着差异，但接受 RAS 抑制剂治疗组的累积 AF 事件发生率显着较低（P= 0.013）。单变量和多变量 Cox 回归分析还显示，RAS 抑制剂治疗与随访期间新发 AF 风险显着降低相关。总之，这项倾向评分匹配研究表明，接受 RAS 抑制剂治疗的高血压患者新发 AF 的发生率较低。
It is still controversial whether treatment with renin-angiotensin system (RAS) inhibitors reduces the risk of incident atrial fibrillation (AF). This longitudinal observational study was performed to investigate the confounder-independent effects of RAS inhibitors on new-onset AF in hypertensive patients. Among 1263 consecutive hypertensive patients who underwent echocardiography, 964 eligible patients (mean age, 63 years) were enrolled as the study population. Forty-nine patients developed new-onset AF during the follow-up period (mean: 4.6 years). Kaplan–Meier analysis showed that the cumulative AF event rate was lower in patients receiving RAS inhibitors than in patients without these drugs, but the difference between these two groups was not significant (P= 0.057). Since the use of RAS inhibitors was influenced by concomitant diabetes, chronic kidney disease and left ventricular hypertrophy, propensity score matching (1: 1) was employed to minimize the influence of selection bias for RAS inhibitors. Clinical and echocardiographic parameters showed no significant differences between the propensity score-matched groups with and without RAS inhibitor therapy (both n= 326), but the cumulative AF event rate was significantly lower in the group receiving RAS inhibitors (P= 0.013). Univariate and multivariate Cox regression analyses also revealed that RAS inhibitor therapy was associated with a significantly lower risk of new-onset AF during the follow-up period. In conclusion, this propensity score matching study demonstrated that the incidence of new-onset AF was lower in hypertensive patients receiving RAS inhibitor therapy.