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Original research article
Renin–angiotensin–aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy
  1. Chen-Yu Huang1,
  2. Yao-Hsu Yang2,3,4,
  3. Lian-Yu Lin1,
  4. Chia-Ti Tsai1,
  5. Juey-Jen Hwang1,
  6. Pau-Chung Chen5,
  7. Jiunn-Lee Lin1
  1. 1 Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
  2. 2 Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
  3. 3 Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
  4. 4 School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
  5. 5 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
  1. Correspondence to Dr Lian-Yu Lin, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei 100, Taiwan; hspenos{at}gmail.com

Abstract

Objectives Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with increased mortality, mainly mediated by increased thromboembolic events and progressive heart failure. Many studies suggested inhibition of renin–angiotensin–aldosterone system (RAAS) could reduce new AF in various clinical conditions. However, evidence concerning the effects of RAAS inhibitors on AF prevention remains unclear in HCM. Our study is to investigate whether treatment with ACE inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) could lower the risk of new AF in HCM.

Methods We conducted a retrospective study including subjects diagnosed HCM between January 1997 and December 2013 by using a nationwide database covering almost all Taiwanese from National Health Research Institute. All participants, aged 18 or older, had no ACEIs or ARBs exposure or AF diagnosis before enrolment. Propensity score matching and multivariate Cox hazard regression were employed to estimate the risk of new AF occurrence.

Results Total 18 266 subjects were included in the analysis with median follow-up duration 8.13 years. Patients taking ACEIs or ARBs are associated with lower risk of developing new AF than those without taking neither of medications (3.16% vs 5.65%, relative risk 0.56 (95% CI 0.49 to 0.64), HR 0.572 (95% CI 0.480 to 0.683)). The correlation is more prominent with longer ACEIs or ARBs treatment (HRs from T1 to T3: 0.741, 0.579, 0.337, P<0.001). These results remain consistent after propensity score adjustment.

Conclusion In patients with HCM, lower risk of new AF is observed in patients treated with either ACEIs or ARBs compared with those receiving neither of these medications.

  • hypertrophic cardiomyopathy
  • atrial fibrillation
  • angiotensin-converting enzyme inhibitors
  • angiotensin-receptor blockers

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Footnotes

  • Contributors L-YL is responsible for the overall content as a guarantor, contributed to the conception and design of the work, acquisition and interpretation of the data and critical revision of the manuscript for important intellectual content. C-YH contributed to the conception and design of the work, analysis and interpretation of data for the work, drafting of the manuscript and revising the manuscript. Y-HY contributed to the conception or design of the work and the acquisition of data for the work. C-TT, J-JH, P-CC and J-LL contributed to the conception and design of the work, interpretation of the data and critical revision of the manuscript for important intellectual content. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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