Atrial fibrillation, or irregular heartbeat, is a major risk factor for thromboembolic events, particularly stroke. This risk is especially high in patients with high blood pressure. Antihypertensive drugs are known to reduce the risk for atrial fibrillation by lowering blood pressure. However, some classes of antihypertensives may have greater risk reduction through other mechanisms. Researchers studied 4,661 patients with atrial fibrillation against 18,642 matched control patients from a population of 682,993 patients treated for hypertension in the United Kingdom. They compared the risk for atrial fibrillation among hypertensive patients taking angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), or beta-blockers to the reference group taking calcium channel blockers. The researchers found that patients on long-term ACE-inhibitor, ARB, or beta blocker therapy had a reduced risk for atrial fibrillation compared to patients on calcium channel blockers. Patients and physicians should consider these differences when choosing an antihypertensive therapy.

4. Higher Statin Doses Not Always Best at Preventing Coronary Artery Disease

Statins have proven highly effective at lowering cholesterol. Typically, a treat-to-target approach, which means treating to a target cholesterol level, is taken with statin therapy. However, some experts believe that a tailored approach that uses different dosages based on pateints' risk for cardiovascular disease may be a better strategy for reducing the risk of coronary artery disease. Researchers developed a computer simulation to compare two treatment approaches at the population level-- giving fixed doses of statins on the basis of a person's five-year coronary artery disease risk (tailored treatment), or increasing statin doses to achieve particular lipid level targets (treat-to-target). Compared with the intensive treat-to-target approach, the tailored fixed-dose strategy saved more quality-adjusted life-years and treated fewer persons with high-dose statin therapy. Researchers conclude that tying statin treatment individual risk for heart disease and potential benefits may be better than approaches that focus primarily on achieving certain lipid level targets.

Source: American College of Physicians