Effect Of Valsartan Combined With Bisoprolol And Amiodarone On Patients With Persistent Atrial Fibrillation With Mild Hypertension

To compare the efficacy of valsartan combined with bisoprolol and amiodarone on ventricular rate control,cardiac rhythm restitution and hypotension in patients with persistent atrial fibrillation with mild hypertension,as well as the effects on cardiac structure and function.MethodA total of 80 patients with persistent atrial fibrillation complicated with mild hypertension who were admitted to the Affiliated Central Hospital of Shenyang Medical University from October 2019 to October 2020 were analyzed.According to random number table method,they were divided into group A(valsartan 80mg+bisoprolol 5mg)and group B(valsartan 80mg+ amiodarone 100mg).Both groups were followed up for 6 months.Before treatment and 6 months after treatment,24 h Ambulatory electrocardiogram monitoring(Holter)and 24 h Ambulatory blood pressure were performed Pressure monitoring(ABPM),cardiac ultrasound,and B-type Brain Natriuretic Peptide(BNP)examination.The 24-hour Average heart rate(ADAHR),atrial fibrillation overturn,and 24 h systolic blood pressure(24h)were recorded before and 6 months after treatment in 2 groups ADASBP),All Day Average Diastolic Blood Pressure(ADADBP),The Internal diameter of left atrium(LAD),the interventional tricular septal thickness(IVS),the left interventional septal thickness(LEFT)Ventricular posterior wall thickness(LVPW),Left ventricular ejection fraction(LVEF)and BNP levels,respectively.After 6 months of treatment,the changes of ventricular rate,atrial fibrillation and sinus rhythm,blood pressure,heart structure and heart function in 2 groups were compared.The measurement data were expressed as mean ± standard deviation(?X±S).The t-test of two paired samples and the t-test of two independent samples were used for intra-group comparison before and after the comparison,with P<0.05 as the result,which was statistically significant.The ?2-test was used for counting data,with P<0.05 as the result,which was statistically significant.Result1.Comparison of baseline characteristics between two groups of patientsThere was no statistically significant difference in gender,age,anticoagulation,ADAHR,LAD,IVS,LVPW,LVEF value,BNP,ADASBP,ADADBP and other clinical baseline characteristics of the two groups before treatment(P>0.05).2.The changes of ventricular rate,atrial fibrillation reverting to sinus rhythm,blood pressure,cardiac structure and cardiac function before and after treatment in each group.(1)The above indexes of group A before and 6 months after treatment were as follows:ADAHR(79.76±7.25 times/min vs.69.42±3.76 times/min,P < 0.05),ADASBP(137.50±4.17 mm Hg vs.116.92 ±4.10 mm Hg),P < 0.05),ADADBP(88.92±3.35 mm Hg vs.70.18±3.44 mm Hg,P < 0.05),LAD(41.58±7.87 mm vs.35.10±4.63 mm,P < 0.05),IVS(9.81 ±1.43 mm vs.9.43±0.89 mm,P < 0.05),LVPW(9.68±1.04 mm vs.9.09± 0.57 mm,P < 0.05),LVEF value(52.82±7.68% vs.59.22±7.80%,P < 0.05),BNP(267.90±47.11pg/m L vs.115.90±44.66pg/m L,P <0.05).Compared with before treatment,the above indexes were significantly reduced 6 months after treatment,and no sinus rhythm was recovered in this group.(2)The above indexes of group B before and 6 months after treatment were:ADAHR(78.47±8.02 times/min vs.72.79±5.23 times/min,P < 0.05),ADASBP(137.97±5.58 mm Hg vs.125.08 ±3.72 mm Hg,P < 0.05),ADADBP(88.53±3.06 mm Hg vs.75.89±3.40 mm Hg,P < 0.05),LAD(39.65±6.14 mm vs.37.16±3.67 mm,P < 0.05),IVS(9.99 ±1.23 mm vs.9.45±0.66 mm,P < 0.05),LVPW(10.04±0.92 mm vs.9.66± 0.60 mm,P < 0.05),LVEF value(51.46±8.22%vs.55.48±8.38%,P < 0.05),BNP value(255.27±30.66pg/m L vs162.94±50.43pg/m L,P < 0.05).Compared with before treatment,the above indexes were significantly reduced 6 months after treatment,and 2 patients in this group successfully reverted to sinus rhythm.3.Comparison of ventricular rate,heart rhythm,blood pressure,heart structure and heart function between the two groups before and 6months after treatment:(1)Before treatment,there were no significant differences in ADAHR,LAD,IVS,LVPW,LVEF,BNP,ADASBP and ADADBP between 2 groups(P > 0.05).(2)Comparison of ventricular rate,relapse of atrial fibrillation sinusitis,blood pressure,cardiac structure and cardiac function between group A and group B after 6 months of treatment:ADAHR(69.42±3.76 times/min vs.72.79±5.23times/min,P < 0.05),ADASBP(116.92±4.10 mm Hg vs.125.08±3.72 mm Hg,P <0.05);ADADBP(70.18±3.44 mm Hg vs.75.89±3.40 mm Hg,P < 0.05),LAD(35.10±4.63 mm vs.37.16±3.67 mm,P < 0.05),IVS(9.43±0.89 mm vs.9.45±0.66 mm,P > 0.05),LVPW(9.09±0.57 mm vs.9.66±0.60 mm,P < 0.05),LVEF value(59.22±7.80% vs.55.48±8.38%,P < 0.05),BNP value(115.90± 44.66pg/m L vs.162.94±50.43pg/m L,P < 0.05).After 6 months of treatment,0 patients in group A and 2 patients in group B were successfully restored to sinus rhythm.Ventricular rate,blood pressure,left atrial diameter,left ventricular posterior wall thickness and BNP in group A were all lower than that in group B,and LVEF was higher than that in group B.Conclusion1.Amiodarone 100 mg per day orally for 6 months has the potential to convert persistent atrial fibrillation to sinus rhythm without obvious adverse reactions.2.Amiodarone 100 mg orally per day can reduce the ventricular rate in patients with persistent atrial fibrillation accompanied by mild hypertension,but the reduction in ventricular rate is less than bisoprolol,and the effect of bisoprolol is better.3.For patients with persistent atrial fibrillation with mild hypertension,valsartan combined with bisoprolol or combined with amiodarone can reduce the patient’s systolic and diastolic blood pressure,and the combined bisoprolol group has a greater reduction in blood pressure.Better curative effect.4.For patients with persistent atrial fibrillation accompanied by mild hypertension,valsartan combined with bisoprolol or combined with amiodarone can improve the patient ’ s cardiac structure and reverse cardiac structure remodeling,but the combined oral bisoprolol has a better effect.excellent.5.For patients with persistent atrial fibrillation with mild hypertension,valsartan combined with bisoprolol or combined with amiodarone can improve the patient’s cardiac function,but the combination with bisoprolol has a better effect.