Effects of Angiotensin Converting Enzyme Inhibitors and Statins on Endothelial Function, Inflammation, and Coagulation in Patients with Hypertension and Atrial Fibrillation

Introduction: The renin-angiotensin-aldosterone system has been reported to affect the endothelial function, prothrombotic and hypercoagulable state, and maintenance of atrial fibrillation (AF). Whether angiotensin converting enzyme inhibitors (ACEIs) and statins improve the prothrombotic condition of patients with hypertension and AF is unclear. Materials & Methods: Patients with hypertension and AF were divided into four groups: Group I (N=15; M:F, 10:5; age, 49±6 years) received no ACEI or statin, group II (N=17; M:F, 11:6; age, 48±6 years) received cilazapril 5 mg without statin, group III (N=18; M:F, 9:9; age, 49±7 years) received cilazapril 5 mg and atorvastatin 10 mg, and group IV (N=16; M:F, 10:6; age, 45±3 years) received cilazapril 5 mg and atorvastatin 40 mg. Serum markers of endothelial function (von Willebrand factor [vWF]), inflammation (quantitative and high-sensitivity C-reactive protein, erythrocyte sedimentation rate), and coagulation (fibrinogen, fibrinogen degradation product, d-dimer) were measured at baseline and 6 months. Results: There were no thromboembolism cases in any group during the 6-month follow up. There were no significant differences in the levels of each marker at baseline. There were no significant changes in vWF at 6 months in group I and II; however. it was significantly reduced at 6 months (172±43%, vs. 110±41%, p=0.001) in group III. vWF and fibrinogen levels were significantly reduced at 6 months in group IV (184±52% vs. 150±68%, p=0.021 and 331±73 mg/dL vs. 275±57 mg/dL, p=0.047, respectively). Other markers were not changed significantly in any group. Conclusion: High doses of statin and ACEI may have a beneficial effect on endothelial function and coagulation, which may contribute to the reduction of thromboembolism risk in patients with hypertension and AF.