HYDROCHLOROTHIAZIDE ADDED TO ANGIOTENSIN RECEPTOR BLOCKERS THERAPY MAY INCREASE BLOOD PRESSURE AND ALLOW THE ONSET OF BRIEF PHASES OF ATRIAL FIBRILLATION

Objective: Hypertensive Cardiovascular Disease is a complex, multifactorial, and chronic illness. It is a prevalent, independent, and potentially modifiable risk factor for atrial fibrillation development. Angiotensin Receptor Blockers (ARB) are widely used in patients with arterial hypertension. Hydrochlorothiazide (Hct) could be harmful to the metabolism of carbohydrates and uric acid, and the possibility be the cause of the release of aldosterone even during ARB treatment. The goal of antihypertensive therapy is to prevent cardiovascular complications. This study aimed to know the effect of Hct when added to ARB therapy could increase blood pressure relating to the use of ARB alone. The diuretic could stimulate the appearance of brief phases of atrial fibrillation, considering its capacity to produce metabolic and electrolyte alterations. Design and method: In this retrospective cross-sectional study, 898 hypertensive patients were admitted, 502 women, and 396 men, divided into two treatment groups, with ARB alone (women 248, men 223), and ARB associated with Hct (women 254, men 173). All patients were measured with non-invasive arterial tonometry according to standardized methods for sex and age, and 24-hour Holter monitoring was used. The time therapy groups with/without hydrochlorothiazide added were an average of 31/22 months, respectively. The dose of Hct was an average of 15.6 mg, for both sexes. Results: Both systolic/diastolic Blood Pressure and Central Hemodynamic Parameters (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, principally) in the group Hct associated with ARB therapy, both sexes, were higher, with a statistically significant difference. Furthermore, in the group of Hct associated with ARB therapy (women 17.7%, men 16.2%), a higher percentage of brief phases of atrial fibrillation by 24-hour Holter monitoring was observed, comparing the group ARB alone (women 10.1%, men 6.7%), with a statistically significant difference, possibly by the increasing volume/pressure of the arterial-ventricular coupling by aldosterone “escape” producing a mechanical and electrical atrial remodeling. Conclusions: Hydrochlorothiazide added to Angiotensin Receptor Blocker therapy could increase both systolic/diastolic Blood Pressure, and Central Haemodynamic Parameters according to the non-invasive arterial tonometry measures and allow the onset of brief phases of atrial fibrillation.