ACTIVE-I研究的启示ARB在房颤综合防治中的地位_胡大一.ppt

* * Reference: 1. The ACTIVE Investigators. Rationale and Design of ACTIVE: The atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events. Am Heart J 2006; 151:1187-93 GLB.IRB. 07.12.08 071221a_Irbe Reference: 1. The ACTIVE Investigators. Rationale and Design of ACTIVE: The atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events. Am Heart J 2006; 151:1187-93 Reference: 1. The ACTIVE Investigators. Rationale and Design of ACTIVE: The atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events. Am Heart J 2006; 151:1187-93 * * 首先，ACTIVE-I研究的结果再次提醒在房颤防治中，早期干预策略的重要性。 众多证据表明，高血压与房颤发生发展之间的关系密切，高血压是房颤最强的危险因素之一，持续高血压将导致左室肥厚，心房增大，逐步发生心房颤动，并最终导致脑卒中等心血管事件。因此，尽早控制高血压有益于预防房颤的发生、发展。 ACTIV-I研究中，厄贝沙坦显著降低患者的血压多达3/2mmHg。这可能就是研究中厄贝沙坦降低房颤患者心血管事件13-14%的重要基础。 这提醒我们，对患者采取早期干预措施，有效控制他们的高血压，将有利于房颤的控制 。 Hypertension is the commonest comorbidity associated with AF. In the AFFIRM study, hypertension was a primary diag否sis at enrollment in 51% patients and the prevalent diag否sis in 70%. At the same time, hypertension is a risk factor for stroke in patients with AF. 房颤的发生也与高血压密切相关。 与无高血压的患者相比，高血压患者房颤风险显著增加。 Framingham 研究中高血压患者房颤风险较无高血压患者增加50%， Manitoba 随访研究中增加42%， Rotterdam/Goteborg研究中增加33%，CH 研究中全部房颤增加39%，新发房颤增加11%。 Reference 1. Boos CJ Lin GYH. J Hum Hypertens 2005; 19:855-859. Patients with an episode of persistent AF for 7 days, in the absence of cardiac or extracardiac causes and with normal blood pressure values (lone AF), were recruited. Ninety patients were randomised and scheduled for electrical cardioversion. Three groups of patients were compared: Group I was treated with amiodarone 400 mg daily (30 patients), Group II was treated with amiodarone 400 mg daily plus irbesartan 150 mg daily (30 patients) Group III with amiodarone 400 mg daily plus irbesartan 300 mg daily (30 patients). The primary endpoint was the time to a first recurrence of AF. The patients were cardioverted an