心房颤动上游治疗（一）ARB的作用.pptVIP

在高血压人群中，迄今仅有1项荟萃分析显示ACEI/ARB治疗使发作性房颤的RR显著降低23%，而这一趋势主要由以左室肥厚的高血压患者为研究对象的LIFE试验中所观察到的氯沙坦组新发房颤发生率较阿替洛尔组显著降低33%（6.8 vs. 10.1/1000患者年）的获益所驱动。 * LIFE研究纳入了9193例左室肥厚的高血压患者，随机接受氯沙坦或阿替洛尔为基础的治疗，其中8851例无房颤的患者随访4.8+1.0年。结果显示，氯沙坦组150例患者发生房颤，阿替洛尔组为221例（6.8 vs 10.1/1000病人年，RR 0.67,95%CI 0.55-0.83，P0.001） * 2011年最新发表的一项荟萃分析针对随机对照试验。共检出8项RCT，纳入2323例患者。显示ARB使房颤复发风险显著降低35%（0.643,95%Ci 0.439-0.941,P=0.023）.作者的结论是，这一荟萃分析证实能够显著减少房颤复发。 * 比较了阵发性房颤患者中氯沙坦+胺碘酮与氨氯地平+胺碘酮相比，预防高血压患者房颤复发的作用。这是一项双盲、随机、平行、多中心研究。 * 此外，LIFE研究还发现，与阿替洛尔相比，氯沙坦治疗改善了房颤亚组患者的主要CV结局。主要复合终点（CV死亡、卒中、心肌梗死［MI］）发生率降低达42%；单一事件终点CV死亡率降低42%，卒中减少45%，并呈现降低全因死亡率的趋势。这一亚组分析提示，氯沙坦较阿替洛尔更有效地减少合并LVH的房颤高血压患者的主要心血管终点。而迄今为止，其他ARB并未被证实能够减少房颤患者的心血管终点发生 Study population. The LIFE study was a prospective, randomized, double-blind, parallel-group study with a double-dummy technique. Patients age 55 to 80 years, having previously treated or untreated hypertension and ECG LV hypertrophy randomized to initial therapy with 50 mg/day losartan or atenolol after one to two weeks of placebo if they had a sitting systolic blood pressure of 160 to 200 mm Hg and/or diastolic blood pressure of 95 to 115 mm Hg In both groups, hydrochlorothiazide was added in the case of insufficient pressure lowering. Thereafter the study drug was increased to 100 mg/day and supplemented with additional antihypertensive therapy in order to reach a target blood pressure of 140/90 mm Hg. * J Am Coll Cardiol. 2005 Mar 1;45(5):705-11. Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: The Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. Wachtell K, Hornestam B, Lehto M, Slotwiner DJ, Gerdts E, Olsen MH, Aurup P, Dahl?f B, Ibsen H, Julius S, Kjeldsen SE, Lindholm LH, Nieminen MS, Rokkedal J, Devereux RB. Source Department of Medicine, Glostrup University Hospital, Glostrup, Denmark. kristian@wachtell.net Abstract OBJECTIVES: We assessed the impact of antihypertensive treatment in hypertensive patient