Combined hypotensive treatment with ≥ 3 hypotensive drugs in patients with recurrent atrial fibrillation and arterial hypertension ensures more effective arrhythmia control than using less drugs

Abstract

Background: Combined arterial hypertension (AH) therapy ensures the effectiveness of treatment and improves haemodynamic parameters of cardiac function.

Aim: The evaluation of therapeutic regimens in the prevention of recurrence of atrial fibrillation (AF) episodes in hypertensive patients with paroxysmal/persistent forms of AF.

Methods: Prospective observation included patients (n = 164), without and with AH, grade I and II, with paroxysmal (51.3%) or persistent (48.7%) recurrent form of arrhythmia. Mean duration of AF was 4.0 years, (Q1:2; Q3:7). The anti-arrhythmic drugs were ineffective in prevention of AF episodes or non tolerated and were not used. In all patients precise control of blood pressure (BP) was implemented: patients were treated with beta-blockers: 100%; ACE-I: 65%, spironolactone: 47%, thiazide diuretics: 34%, loop-diuretics: 7%, calcium antagonists: 26.5% and alpha-blockers: 14.5%. Evaluation of symptomatic and confirmed AF episodes was performed every 3 months during 1-year follow-up.

Results: AH, grade I and II, was diagnosed in 115, 75%, of patients; (74% men, mean age 65.5 ± 9.7 years). Persistent form of arrhythmia was more frequent in patients with AH: 83% in comparison with patients without AH: 67% (p < 0.05). BP values were similar in normotensive and hypertensive patients after completing the study: 123 ± 9/79 ± 4 vs. 124 ± 10/80 ± 0.5 mm Hg. One hypotensive drug was used in 6 patients, 2 drugs in 38 patients, 3 in 37, 4 in 27, 5 in 7. Patients treated with . 3 drugs had more AF episodes in 3 months prior to evaluation: 4.7 ± 0.8 vs. 2.9 ± 0.4, p = 0.0444. But during 1-year follow-up, observed in 3-months periods, they had significant reduction in every 3-months period, p = 0.0001. Patients treated with 1.2 drugs had significant reduction after 3 months: p = 0.0029, 6 months: p = 0.04 and 12 months: p = 0.0012, but not after 9 months.

Conclusions: AH promotes more advanced AF forms occurrence. Combined hypotensive therapy with minimum 3 drugs, including RAA inhibitors, may be effective in terms of BP control and reduction of arrhythmia episodes.