A 60-year-old man attends clinic because of hypertension. His BP in clinic is 170/90 mmHg and his echocardiogram shows mild LVH and mild LA dilatation. He is not diabetic and has no other medical history of note.
Which one of the following medications is most effective in preventing AF?
A. ACE inhibitors
B. Beta-blockers
C. Calcium-channel antagonists
D. Diuretics
E. Alpha-blockers
Answer:
A. ACE inhibitors
Discussion: ACE inhibitors and ARBs have antifibrillatory and antifibrotic properties.
A meta-analysis has shown that ACE inhibitors and angiotensin-receptor blockers (ARBs) reduce the relative risk of incident AF by 25%. The LIFE study, in particular, showed a 33% reduction in new-onset AF in patients with LVH treated with losartan compared with those treated with atenolol.
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