Abstract：
BACKGROUND: Hypertension is associated with left ventricular hypertrophy/enlargement/fibrosis and atrial ectopic rhythm, leading to an increased risk of Atrial Fibrillation (AF). We aimed to stratify the effect of Angiotensin Converting Enzyme Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) on the risk of AF.
METHODS: PubMed, Scopus, and Google Scholar databases were screened, and cross-citation was conducted for studies reporting AF in hypertensive patients on ACEi and ARB. Of 145 studies found till May 2023, 19 were included in this study. Binary random-effects models estimated the pooled odds ratios, I2 statistics assessed heterogeneity and sensitivity analysis was assessed using the leave-one-out method.
RESULTS: 153,559 hypertensive patients met the inclusion criteria. For incidental AF, ACEi and ARB showed a significant decrease in both unadjusted (OR 0.75, 95% CI [0.66-0.85], I² = 20.79%, p=0.29) and adjusted risks (OR 0.76, 95% CI [0.62-0.93], I² = 88.41%, p<0.01). In recurrent AF, the unadjusted analysis showed no significant effect (OR 0.89, 95% CI [0.55-1.42], I² = 78.44%, p<0.01), while the adjusted analysis indicated a reduced risk (OR 0.62, 95% CI [0.50-0.76], I² = 65.71%, p<0.01). Leave-one-out sensitivity analysis confirmed these results.
CONCLUSIONS: ACEi and ARB considerably decrease the risk of incidental and recurrent AF in hypertensive patients, emphasizing the importance of treating clinical hypertension with these drugs.
METHODS: PubMed, Scopus, and Google Scholar databases were screened, and cross-citation was conducted for studies reporting AF in hypertensive patients on ACEi and ARB. Of 145 studies found till May 2023, 19 were included in this study. Binary random-effects models estimated the pooled odds ratios, I2 statistics assessed heterogeneity and sensitivity analysis was assessed using the leave-one-out method.
RESULTS: 153,559 hypertensive patients met the inclusion criteria. For incidental AF, ACEi and ARB showed a significant decrease in both unadjusted (OR 0.75, 95% CI [0.66-0.85], I² = 20.79%, p=0.29) and adjusted risks (OR 0.76, 95% CI [0.62-0.93], I² = 88.41%, p<0.01). In recurrent AF, the unadjusted analysis showed no significant effect (OR 0.89, 95% CI [0.55-1.42], I² = 78.44%, p<0.01), while the adjusted analysis indicated a reduced risk (OR 0.62, 95% CI [0.50-0.76], I² = 65.71%, p<0.01). Leave-one-out sensitivity analysis confirmed these results.
CONCLUSIONS: ACEi and ARB considerably decrease the risk of incidental and recurrent AF in hypertensive patients, emphasizing the importance of treating clinical hypertension with these drugs.
摘要：
背景：高血压与左心室肥厚/扩大/纤维化和心房异位心律有关，导致心房颤动（AF）的风险增加。我们旨在分层血管紧张素转换酶抑制剂（ACEi）和血管紧张素受体阻滞剂（ARB）对AF风险的影响。
方法：PubMed，Scopus,谷歌学者数据库被筛选，并交叉引用了ACEi和ARB高血压患者房颤报告的研究。在2023年5月之前发现的145项研究中，有19项纳入了这项研究。二元随机效应模型估计了合并的赔率比，I2统计学评估异质性，敏感性分析使用留一法进行评估。
结果：153,559例高血压患者符合纳入标准。对于偶然的AF,ACEi和ARB均显示出未调整的显着下降（OR0.75，95％CI[0.66-0.85]，I²=20.79%,p=0.29)和调整后的风险(OR0.76，95%CI[0.62-0.93]，I²=88.41%，p<0.01)。在复发性房颤中,未调整分析显示无显著影响(OR0.89，95%CI[0.55-1.42]，I²=78.44%，p<0.01),而调整后的分析表明风险降低(OR0.62，95%CI[0.50-0.76]，I²=65.71%，p<0.01)。留一法敏感性分析证实了这些结果。
结论：ACEi和ARB可显著降低高血压患者偶发和复发房颤的风险，强调用这些药物治疗临床高血压的重要性。
方法：PubMed，Scopus,谷歌学者数据库被筛选，并交叉引用了ACEi和ARB高血压患者房颤报告的研究。在2023年5月之前发现的145项研究中，有19项纳入了这项研究。二元随机效应模型估计了合并的赔率比，I2统计学评估异质性，敏感性分析使用留一法进行评估。
结果：153,559例高血压患者符合纳入标准。对于偶然的AF,ACEi和ARB均显示出未调整的显着下降（OR0.75，95％CI[0.66-0.85]，I²=20.79%,p=0.29)和调整后的风险(OR0.76，95%CI[0.62-0.93]，I²=88.41%，p<0.01)。在复发性房颤中,未调整分析显示无显著影响(OR0.89，95%CI[0.55-1.42]，I²=78.44%，p<0.01),而调整后的分析表明风险降低(OR0.62，95%CI[0.50-0.76]，I²=65.71%，p<0.01)。留一法敏感性分析证实了这些结果。
结论：ACEi和ARB可显著降低高血压患者偶发和复发房颤的风险，强调用这些药物治疗临床高血压的重要性。
