Long-term effect of antihypertensive drugs on the risk of new-onset atrial fibrillation: a longitudinal cohort study.

Antihypertensive drugs have been linked to new-onset atrial fibrillation (NAF); however, the way in which these drugs affect the development of NAF in hypertensive patients has not been thoroughly examined. Herein, we report a population-based study in which we investigated the relationship between antihypertensive drug therapy and the risk of NAF. The population sample consisted of 47 682 hypertensive patients identified from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan between January 2005 and December 2010. Prescriptions for antihypertensive drugs prescribed before the index date were retrieved from a prescription database. From these data, we estimated the hazard ratio (HR) of NAF associated with antihypertensive drug use; non-NAF subjects served as the reference group. After adjusting for age and sex, we observed that the risk of NAF was higher among the patients taking diuretics (HR, 1.39; 95% confidence interval (CI), 1.06-1.82) compared with the patients not taking diuretics. Patients who took angiotensin-converting enzyme (ACE) inhibitors (HR, 0.79; 95% CI, 0.65-0.97) showed a lower risk of developing NAF compared with the nonusers of ACE inhibitors. Angiotensin receptor blockers, alpha-blockers, beta-blockers and calcium channel blockers were not associated with a risk of NAF. The results of this study suggest that hypertensive patients who take diuretics have a significant increase in the risk of NAF, whereas patients who take ACE inhibitors are at lower risk of NAF.