The Role of Renin–Angiotensin System Blockade Therapy in the Prevention of Atrial Fibrillation: A Meta‐Analysis of Randomized Controlled Trials

Current evidence suggests that angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have emerged as novel drugs for preventing the development of atrial fibrillation (AF). A meta‐analysis was performed of 26 randomized controlled clinical trials evaluating the effect of ACEIs or ARBs on the prevention of AF. Overall, ACEIs and ARBs revealed statistically significant preventive effects on AF (odds ratio (OR), 0.65; 95% confidence interval (CI), 0.55–0.76). The preventive effect was similar in the two classes of drugs (ACEI: OR, 0.68; ARB: OR, 0.69). ACEIs and ARBs showed greater preventive effects on recurrent AF (OR, 0.45; 95% CI, 0.31–0.65) than on new‐onset AF (OR, 0.80; 95% CI, 0.70–0.92). Prevention was greatest in patients with AF who were receiving amiodarone as a basic treatment drug (OR, 0.35; 95% CI, 0.26–0.48). In patients with heart failure, there appeared to be a large effect (OR, 0.497), but the credible interval (CrI) limits were wide (95% CrI, 0.187–1.161). Clinical Pharmacology & Therapeutics (2010) 88 4, 521–531. doi:10.1038/clpt.2010.123