Front Cardiovasc Med. 2024;11:1372505.

Association between types of antihypertensive medication and the risk of atrial fibrillation: a nationwide population study.

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제1저자 최정민, 이소령 · 교신저자 최의근

PMID 38784173 PMC11111936 DOI 10.3389/fcvm.2024.1372505 IF 3 순환기내과

소속 (6)

Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Liverpool Center for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

BACKGROUND Patients with hypertension are at a high risk of atrial fibrillation (AF). Recent research has indicated the varying effects of antihypertensive medications on developing AF.

OBJECTIVES We investigated the relationship between different types of antihypertensive medications and the risk of AF occurrence.

METHODS We analyzed data from 113,582 subjects with national health screening examinations between 2009 and 2014. The study population was categorized according to antihypertensive medication type. The primary outcome was the incidence of AF.

RESULTS Among 113,582 subjects (mean age 59.4 ± 12.0 years, 46.7% men), 93,557 received monotherapy [angiotensin receptor blockers (ARB), angiotensin-converting enzyme inhibitors (ACEi), beta-blockers, calcium channel blockers (CCB), or diuretics], while 34,590 received combination therapy (ARB/beta-blockers, ARB/CCB, ARB/diuretics, or ARB/CCB/diuretics). During a mean follow-up duration of 7.6 ± 2.1 years, 3.9% of patients were newly diagnosed with AF. In monotherapy, ACEi and CCB had similar AF risks as ARB, while beta-blockers and diuretics showed higher AF risks than ARB. In combination therapy, ARBs/CCBs and ARBs/diuretics had the lowest AF risk, whereas ARBs/beta-blockers had the highest compared to ARB/CCB. Among the specific ARBs, the AF risk varied insignificantly, except for telmisartan and candesartan.

CONCLUSIONS In hypertensive patients receiving monotherapy, ACEi and CCB showed a similar AF risk as ARBs, while beta-blockers and diuretics were associated with a higher risk. Among those receiving combination therapy, ARBs/CCBs and ARBs/diuretics had the lowest AF risk, whereas ARBs/beta-blockers showed the highest risk. Various types of ARBs have different associations with AF risk.

Keywords

angiotensin receptor blocker (ARBs)angiotensin-converting enzyme inhibitors (ACEi)antihypertensive medicationatrial fibrillationbeta blockercalcium channel blocker (CCB)diureticshypertension

Figures

**Figure 1** Study design. ARB, angiotensin II receptor blocker; ACEi, angiotensin-converting enzyme inhibitor; BB, beta-blocker; CCB, calcium channel blocker; NHIC, national health insurance corporation.

**Figure 2** Hazard ratio and incidence rate comparison in each antihypertensive medication group; (A) monotherapy group (B) combination therapy group (C) specific ARB type in ARB only prescribed group (D) specific ARB type in combination with other medication group. Model 4: model adjusted for age, sex, comorbidities (diabetes mellitus, dyslipidemia, previous myocardial infarction, heart failure, peripheral artery disease, chronic kidney disease, stroke/transient ischemic attack, chronic obstructive pulmonary disease, thyroid disease, and sleep apnea), and social habits (smoking, alcohol consumption, regular exercise, and low income), health screening examination measurements (SBP, fasting glucose level, total cholesterol, and BMI) and hypertension duration. ARB, angiotensin II receptor blocker; ACEi, angiotensin-converting enzyme inhibitor; BB, beta-blockers; CCB, calcium channel blocker; CI, confidence interval; HTN, hypertension.

**Figure 3** Cumulative incidence curves of AF stratified by antihypertensive medication; (A) monotherapy (B) combination (C) specific type of ARB in ARB monotherapy patients. ARB, angiotensin II receptor blocker; ACEi, angiotensin-converting enzyme inhibitor; BB, beta-blocker; CCB, calcium channel blocker; D, diuretic.

그림 출처: PubMed Central 공개 논문 (PMC11111936)

Conflict of interest statement

S-RL: Speaking fees from Bayer, BMS/Pfizer, Biosense Webster, Daiichi-Sankyo, Sanofi-Aventis, Daewoong Pharmaceutical Co., Samjinpharm, Seers Technology, Biotronik, Boston Scientific, and Medtronic. Consultant for Biosense Webster. E-KC: Research grants or speaking fees from Abbott, Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daewoong Pharmaceutical Co., Daiichi-Sankyo, DeepQure, Dreamtech Co., Ltd., Jeil Pharmaceutical Co., Ltd., Medtronic, Samjinpharm, Seers Technology, and Skylabs. GL: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Anthos and Daiichi-Sankyo. GL is a National Institute for Health and Care Research Senior Investigator and co-principal investigator of the AFFIRMO project on multimorbidity in AF, which received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 899871. No personal fees were received. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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