ABSTRACT
INTRODUCTION: Hypertension is associated with left ventricular hypertrophy/enlargement/fibrosis and atrial ectopic rhythm, leading to an increased risk of Atrial Fibrillation (AF). We aimed to stratify the effect of Angiotensin Converting Enzyme Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) on the risk of AF. METHODS: PubMed, Scopus, and Google Scholar databases were screened, and cross-citation was conducted for studies reporting AF in hypertensive patients on ACEi and ARB. Of 145 studies found till May 2023, 19 were included in this study. Binary random-effects models estimated the pooled odds ratios, I2 statistics assessed heterogeneity and sensitivity analysis was assessed using the leave-one-out method. RESULTS: 153,559 hypertensive patients met the inclusion criteria. For incidental AF, ACEi and ARB showed a significant decrease in both unadjusted (OR 0.75, 95% CI [0.66-0.85], I² = 20.79%, p=0.29) and adjusted risks (OR 0.76, 95% CI [0.62-0.93], I² = 88.41%, p<0.01). In recurrent AF, the unadjusted analysis showed no significant effect (OR 0.89, 95% CI [0.55-1.42], I² = 78.44%, p<0.01), while the adjusted analysis indicated a reduced risk (OR 0.62, 95% CI [0.50-0.76], I² = 65.71%, p<0.01). Leave-one-out sensitivity analysis confirmed these results. CONCLUSIONS: ACEi and ARB considerably decrease the risk of incidental and recurrent AF in hypertensive patients, emphasizing the importance of treating clinical hypertension with these drugs.
ABSTRACT
BACKGROUND: Master Health Checkup (MHC) is a battery of tests done to detect and identify Non Communicable Diseases (NCDs) early. But it should also be noted that some tests in MHC have no known benefits for otherwise healthy adults. This study was conducted to evaluate the usefulness of MHC in a hospital based setting. METHODS: A cross-sectional study was conducted among 337 subjects aged 18 years and above who attended the MHC Clinic during the study period. They were subjected to interview and various biochemical investigations to estimate the number of newly diagnosed, clinically relevant abnormalities among apparently normal adults using standard guidelines. Categorical data summarized as frequencies with percentages. Chi-square test was used to compare proportions. RESULTS: Among the 337 participants, 244 were apparently normal with a gender distribution as 109 (44.7%) males and 135 (55.3%) females. The study was able to newly detect 12.3% with Type 2 diabetes, 37.7% in pre-diabetic stage, 54.1% with anaemia, 42.2% with dyslipidemia, 11.5% with hypothyroidism, 27% with liver disorders and 6.5% with renal disorders, about which the participants were unaware of. Females also had statistically significant association with dyslipidaemia and hypothyroidism compared to males with a p-value of 0.004, 0.026 respectively. Apparently normal participants aged > 35 years had strong statistical association with diabetic status and dyslipidemia compared to those aged between 18 - 35 years (p-value 0.001). CONCLUSION: Based on the results from the study it is evident that a significant number of NCDs were newly identified by Master Health checkup (MHC).