Effect of ramipril/hydrochlorothiazide and ramipril/canrenone combination on atrial fibrillation recurrence in hypertensive type 2 diabetic patients with and without cardiac autonomic neuropathy

• Main Authors: Daniele Bosone, Alfredo Costa, Natascia Ghiotto, Matteo Cotta Ramusino, Annalisa Zoppi, Angela D’Angelo, Roberto Fogari
• Format: Article
• Language: English
• Published: Termedia Publishing House 2016-09-01
• Series: Archives of Medical Science
• Subjects: diabetes mellitus; atrial fibrillation; antihypertensive treatment; canrenone; cardiac autonomic neuropathy
• Online Access: https://www.termedia.pl/Effect-of-ramipril-hydrochlorothiazide-and-ramipril-canrenone-combination-on-atrial-fibrillation-recurrence-in-hypertensive-type-2-diabetic-patients-with-and-without-cardiac-autonomic-neuropathy,19,28358,1,1.html

Introduction: The aim of this study was to compare the effect of ramipril/canrenone versus ramipril/hydrochlorothiazide (HCTZ) combination on atrial fibrillation (AF) recurrence in type 2 diabetic hypertensives with and without cardiac autonomic neuropathy (CAN). Material and methods : A total of 289 hypertensive type 2 diabetic patients, 95 with CAN, in sinus rhythm but with at least two episodes of AF in the previous 6 months were randomized to ramipril 5 mg plus canrenone 50 mg (titrated to 10/100 mg) or to ramipril 5 mg plus HCTZ 12.5 mg (titrated to 10/25 mg) or to amlodipine 5 mg (titrated to 10 mg) for 1 year. Clinic blood pressure (BP) and a 24-h ECG were evaluated monthly. Patients were asked to report any episode of symptomatic AF and to perform an ECG as early as possible. Serum procollagen type I carboxy-terminal peptide (PIP) and carboxy-terminal telopeptide of collagen type I (CITP) were evaluated before and after each treatment period. Results : Blood pressure was similarly and significantly reduced by all treatments. A total of 51% of patients with amlodipine had a recurrence of AF, as did 31% of patients with ramipril/HCTZ (p < 0.05 vs amlodipine) and 13% of patients with ramipril/canrenone (p < 0.01 vs amlodipine and p < 0.05 vs ramipril/HCTZ). A similar trend was found in diabetic patients with CAN. Both combinations reduced PIP and increased CITP, but the effects of ramipril/canrenone were significantly more marked. Conclusions : These findings suggest that in type 2 diabetic hypertensives, ramipril/canrenone treatment was more effective than ramipril/HCTZ in reducing AF recurrence. This could be related to the greater improvement in cardiac fibrosis.