Upstream Therapy Of Valsartan And Its Combination With Fluvastatin In Treating The Patients With Atrial Fibrillation

Objective: To investigate weather valsartan or its combination with Fluvastatin may reduce the recurrence rate of non-permanent atrial fibrillation(AF)in patients with hypertension,and to prolong the prognosis time from non-permanent AF to permanent AF.Methods: The study is a randomized,multicenter,openlabel,and three-arm parallel study.From February 2013 to July 2016,One hundred and forty-three cases of patients whom were admitted to outpatient and inpatient department of Second Hospital of Tianjin Medical University,Tianjin People’s Hospital,Tianjin Dongli Hospital and other 5 hospitals,diagnosed as hypertension combining non-permanent atrial fibrillation were included in the study.They were randomly assigned to one of three groups: the dihydropyridine CCBs group(group Ⅰ,n=47)was treated with conventional treatments plus dihydropyridine CCBs,the valsartan group(group Ⅱ,n=46)was treated with conventional treatments plus valsartan and the valsartan plus fluvastatin group(group Ⅲ,n=50)was treated with conventional treatments plus valsartan and fluvastatin,initially in a 1:1:1 ratio.The duration of observation was up to two years.The recurrence rate,incidence of the progression from nonpermanent AF to permanent AF,heart rate variability and AF burden were compared in three groups at before and after 6,12 and 24-month of treatment.Ultrasound echocardiography and biochemical indexes will be performed before the patients enter the study and at the end of the follow-up period.Results: The interventricular septal thickness,left atrial diameter and Hs-CRP of group Ⅱ,Ⅲ were lower significantly than group Ⅰ.The left ventricular ejection fraction of all patients in three groups was higher than before,but the difference has no statistical significance.The level of NT-BNP in group Ⅲ was obviously lower than that before treatment(P = 0.034),but there was no significant change in theother two groups.During the 12 month treatments,the SDNN,SDANN,SDNN Index,RMSSD,PNN50 were all increased.In addition,all of them in group Ⅱ,Ⅲwere noticeably higher than those in group Ⅰ at the end of the follow-up,with significant differences(P < 0.05).In addition,the f wave amplitude and ff wave interval of patients in group Ⅱand Ⅲ were significantly higher than those in groupⅠ,and the AF burden and mean heart rate of group Ⅱand Ⅲ ’s patients were lower than in group Ⅰ(P<0.05).At 12th-month,the group Ⅱ,Ⅲ patients’ maintenance rates of sinus rhythm were significantly higher than group Ⅰ,and the incidence of the progression from non-permanent AF to permanent AF of group Ⅱ,Ⅲ were lower significantly than group Ⅰ(P<0.05).And this trend more clearly with the extension of treatment time.Moreover,This study also found that the group Ⅲpatients’ incidence of the progression from non-permanent AF to permanent AF were obviously lower than group Ⅱ(P<0.05)at the end of the follow-up.Conclusion: Valsartan can inhibit the enlargement of left atrium,reduce atrial remodeling,improve left ventricular function,downregulate inflammatory response,modulate autonomic nervous system,improve the heart rate variability to decrease the AF burden,reduce the recurrence rate of non-permanent AF and to prolong the prognosis time from non-permanent AF to permanent AF in patients with hypertension combining non-permanent atrial fibrillation.Furthermore,the combined application of valsartan and fluvastatin is more effective than valsartan alone.Results of this study informed the use of upstream therapies of AF.