Table1_Association between types of antihypertensive medication and the risk of atrial fibrillation: a nationwide population study.docx

BackgroundPatients with hypertension are at a high risk of atrial fibrillation (AF). Recent research has indicated the varying effects of antihypertensive medications on developing AF.
ObjectivesWe investigated the relationship between different types of antihypertensive medications and the risk of AF occurrence.
MethodsWe 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.
ResultsAmong 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.
ConclusionsIn 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.

研究背景：高血压患者发生心房颤动（atrial fibrillation, AF）的风险较高。近期研究表明，不同类型的降压药物对心房颤动发生风险的影响存在差异。
研究目的：本研究旨在探讨不同类型降压药物与心房颤动发生风险之间的关联。
研究方法：本研究分析了2009年至2014年间113582名接受全国健康筛查受试者的数据。研究队列根据所使用的降压药物类型进行分组，主要结局指标为心房颤动的发生率。
研究结果：本研究纳入的113582名受试者平均年龄为59.4±12.0岁，男性占比46.7%。其中93557名受试者接受单药治疗，包括血管紧张素Ⅱ受体拮抗剂（angiotensin receptor blockers, ARB）、血管紧张素转换酶抑制剂（angiotensin-converting enzyme inhibitors, ACEi）、β受体阻滞剂、钙通道阻滞剂（calcium channel blockers, CCB）及利尿剂；另有34590名受试者接受联合治疗，方案包括ARB/β受体阻滞剂、ARB/CCB、ARB/利尿剂以及ARB/CCB/利尿剂。在平均7.6±2.1年的随访期间，共有3.9%的受试者被新诊断为心房颤动。单药治疗组中，ACEi与CCB的心房颤动发生风险与ARB相当，而β受体阻滞剂与利尿剂的心房颤动发生风险高于ARB。联合治疗组中，与ARB/CCB方案相比，ARB/CCB与ARB/利尿剂方案的心房颤动发生风险最低，ARB/β受体阻滞剂方案的风险最高。在不同亚型ARB中，除替米沙坦（telmisartan）与坎地沙坦（candesartan）外，其余亚型ARB的心房颤动发生风险无显著差异。
研究结论：对于接受单药治疗的高血压患者，ACEi与CCB的心房颤动发生风险与ARB相当，而β受体阻滞剂与利尿剂的相关风险更高。在接受联合治疗的患者中，ARB/CCB与ARB/利尿剂方案的心房颤动发生风险最低，ARB/β受体阻滞剂方案的风险最高。不同亚型ARB与心房颤动发生风险的关联存在差异。