Objectives Previous studies have suggested that Angiotensin-receptor blockers (ARBs) can reduce the incidence and recurrence of atrial fibrillation (AF). Recent studies started to focus on the effect of ARBs on prognosis of AF patients. In this study, we collected the existing evidence to conduct a comprehensive analysis on whether ARBs can reduce cardiovascular events in AF patients.
Methods We performed a meta-analysis, searching EMBASE, PubMed and Cochrane Library from 1970 to 2012, for randomised controlled trials (RCTs) on ARBs in AF patients. Primary outcomes were cardiovascular death, stroke, and major adverse cardiovascular events (MACE); secondary outcomes were myocardial infarction (MI), hospitalisation for heart failure, and all-cause mortality.
Results We identified 4 RCTs (LIFE, CHARM, J-RHYTHM II and ACTIVE I) enrolling 10,824 patients who fulfilled our inclusion criteria. when compared with control, ARBs was associated with no significant improvement in cardiovascular death (risk ratio [RR], 0.98; 95% confidence intervals [CI], 0.90–1.07), stroke (RR, 0.90; 95% CI, 0.79–1.02), MACE (0.87; 95% CI, 0.71–1.07), MI (RR, 1.08; 95% CI, 0.87–1.36), all-cause mortality (RR 0.98; 95% CI, 0.91–1.06), but a significant reduce on hospitalisation for heart failure (RR 0.87; 95% CI, 0.79–0.96).
Conclusions ARBs do not reduce cardiovascular events of AF patients expect hospitalization for heart failure. For the limited evidence, it is still uncertain to use ARBs in AF patients beyond blood pressure lowering and heart failure treatment.