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Analysis of the renin-angiotensin-aldosterone system in men with hypertension and atrial fibrillation
https://doi.org/10.30629/0023-2149-2025-103-10-11-753-759
Abstract
A group of men with hypertension (HT) was examined. The patients were divided into three groups: those with paroxysmal atrial fibrillation (AF), those with persistent AF, and those with coronary artery disease (CAD) (2–3 FC angina).When analyzing the parameters of the renin-angiotensin-aldosterone system, it was revealed that patients with GB and AF are more likely to have high–grade arterial hypertension (AH) (up to 50%), and in patients with GB and CHD — normorenin hypertension (60%). Among patients with high-RH hypertension, significantly higher renin values were noted in the group with persistent AF and coronary artery disease. Against the background of taking antihypertensive therapy (b-blockers and BAR), the level of aldosterone was within the normal range in all examined patients. The high level of angiotensin II in the group of persons with high-renin AH and AF requires further study. Hypokalemia was detected only in patients with hypertension and paroxysmal AF in 13.4% of cases. It should be noted that a low level of K+ from 3.5 to 3.9 mmol/L was detected in 34.2% of patients with paroxysmal AF and in 30% of patients with persistent AF. No correlation was found between the renin-angiotensin-aldosterone system and the K+ level.
About the Authors
T. A. Bobyleva
Russian Medical Academy of Continuous Professional Education; Branch of the Military Medical Academy of S.M. Kirov of the Russian Ministry of Defense In Moscow
Russian Federation
Russian Federation
Tatyana A. Bobyleva — Candidate of Medical Sciences, Associate Professor of the Department of Clinical Physiology and Functional Diagnostics of the Russian Medical Academy of Continuous Professional Education; Associate Professor of the Department of Emergency Medicine of the Branch of the Military Medical Academy of S.M. Kirov in Moscow.
Moscow
S. B. Tkachenko
Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Sergey B. Tkachenko — Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Clinical Physiology and Functional Diagnostics of the Russian Medical Academy of Continuous Professional Education.
Moscow
S. P. Kazakov
Main Military Clinical Hospital named after academician N.N. Burdenko of the Ministry of Defense of the Russia; Federal Research and Clinical Center of Specialized Types of Health Care and Medical Technology of the Federal Medical and Biological Agency
Russian Federation
Russian Federation
Sergey P. Kazakov — Doctor of Medical Sciences, Professor of the Department of Clinical Laboratory Diagnostics, Medical Microbiology and Pathological Anatomy Academy of Postgraduate Education FRCC of the FMBA; Head of the Center for Clinical Laboratory Diagnostics of the Main Military Clinical Hospital named after academician N.N. Burdenko.
Moscow
S. B. Putkov
Main Military Clinical Hospital named after academician N.N. Burdenko of the Ministry of Defense of the Russia
Russian Federation
Russian Federation
Stanislav B. Putkov — M.D. Head of Dept, of Clinical and Infectious-Immunological Research of Centre for Clinical Laboratory Diagnostics of the Main Military Clinical Hospital named after academician N.N. Burdenko.
Moscow
References
1. Bukvalnaya N.V., Yakubova L.V., Snezhitsky A.V. Arterial hypertension and atrial fibrillation: molecular genetic aspects of pathogenesis and complex therapy, focus on the renin-angiotensin-aldosterone system. Emergency Cardiology and Cardiovascular Risks. 2020;4(2):986-993. (In Russian). eLIBRARY ID: 65946
2. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C., et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021;42(5):373-498. DOI: 10.1093/eurheartj/ehaa612
3. Mancia G., Kreutz R., Brunström M., Burnier M., Grassi G., Januszewicz A., et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J. Hypertens. 2023;41(12):1874-2071. DOI: 10.1097/HJH.0000000000003480
4. Writing Committee Members; Joglar J.A., Chung M.K., Armbruster A.L., Benjamin E.J., Chyou J.Y. et al. 2023 ACC/AHA/ACCP/ HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J. Am. Coll. Cardiol. 2024;83(1):109-279. DOI: 10.1016/j.jacc.2023.08.017
5. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I. et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024;29(9):6117. (In Russian). DOI: 10.15829/1560-4071-2024-6117
6. Krahn A.D., Manfreda J., Tate R.B., Mathewson F.A., Cuddy T.E. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am. J. Med. 1995;98(5):476-84. DOI: 10.1016/S0002-9343(99)80348-9
7. Healey J.S., Connolly S.J. Atrial fibrillation: hypertension as a causative agent, risk factor for complications, and potential therapeutic target. Am. J. Cardiol. 2003;91(10A):9G-14G. DOI: 10.1016/s0002-9149(03)00227-3
8. Melekhov A.V., Gendlin G.E., Alekseeva E.M., Dadashova E.F., Nikitin I.G., Matsokin I.S. Prevention of Stroke in Atrial Fibrillation: Wishful Thinking and Reality. Neurology. 2017;09(153):30-35. (In Russian). [Electronic resource]. URL: https://elib.usma.ru/bitstream/usma/13545/1/UMJ_2017_153_9_006.pdf
9. Van Gelder I.C., Rienstra M., Bunting K.V., Casado-Arroyo R., Caso V., Crijns H.J.G.M. et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2024;45(36):3314-3414. DOI: 10.1093/eurheartj/ehae176
10. Allessie M., Ausma J., Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54(2):230-46. DOI: 10.1016/s0008-6363(02)00258-4
11. Packer M. Characterization, Pathogenesis, and Clinical Implications of Inflammation-Related Atrial Myopathy as an Important Cause of Atrial Fibrillation. J. Am. Heart Assoc. 2020;9(7):e015343. DOI: 10.1161/JAHA.119.015343
12. Tsang T.S., Barnes M.E., Bailey K.R., Leibson C.L., Montgomery S.C., Takemoto Y. et al. Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin. Proc. 2001;76(5):467-75. DOI: 10.4065/76.5.467
13. Gaita F., Blandino A. Atrial fibrillation. Left atrial fibrosis — a promising stroke risk factor? Nat. Rev. Cardiol. 2011;8(6):307-8. DOI: 10.1038/nrcardio.2011.63
14. Hirsh B.J., Copeland-Halperin R.S., Halperin J.L. Fibrotic atrial cardiomyopathy, atrial fibrillation, and thromboembolism: mechanistic links and clinical inferences. J. Am. Coll. Cardiol. 2015;65(20):2239-51. DOI: 10.1016/j.jacc.2015.03.557
15. Coats A.J.S., Heymans S., Farmakis D., Anker S.D., Backs J., Bauersachs J., et al. Atrial disease and heart failure: the common soil hypothesis proposed by the Heart Failure Association of the European Society of Cardiology. Eur. Heart J. 2022;43(17):1635. DOI: 10.1093/eurheartj/ehac124
16. Boldt A., Wetzel U., Weigl J., Garbade J., Lauschke J., Hindricks G., et al. Expression of angiotensin II receptors in human left and right atrial tissue in atrial fibrillation with and without underlying mitral valve disease. J. Am. Coll. Cardiol. 2003;42(10):1785-92. DOI: 10.1016/j.jacc.2003.07.014
17. Maksimov M.L., Dralova O.V., Kupreychik V.L., Mochkin V.A. Laboratory diagnostics of the activity of the renin-angiotensin-aldosterone system. Creative Cardiology. 2010;(1):54-61. (In Russian). [Electronic resource]. URL: https://cardiology-journal.com/EN/catalog/detail.php?SECTION_ID=962&ID=17298 (data access 11.06.2025).
18. L'Allier P.L., Ducharme A., Keller P.F., Yu H., Guertin M.C., Tardif J.C. Angiotensin-converting enzyme inhibition in hypertensive patients is associated with a reduction in the occurrence of atrial fibrillation. J. Am. Coll. Cardiol. 2004;44(1):159-64. DOI: 10.1016/j.jacc.2004.03.056
19. McEwan P.E., Gray G.A., Sherry L., Webb D.J., Kenyon C.J. Differential effects of angiotensin II on cardiac cell proliferation and intramyocardial perivascular fibrosis in vivo. Circulation. 1998;98(24):2765-73. DOI: 10.1161/01.cir.98.24.2765
20. Aldhoon B., Melenovsky V, Peichl P., Kautzner J. New insights into mechanisms of atrial fibrillation. Physiol Res. 2010;59(1):1-12. DOI: 10.33549/physiolres.931651
21. Kostin S., Klein G., Szalay Z., Hein S., Bauer E.P., Schaper J. Structural correlate of atrial fibrillation in human patients. Cardiovasc. Res. 2002;54(2):361-79. DOI: 10.1016/s0008-6363(02)00273-0
22. Grönefeld G.C., Hohnloser S.H. Heart failure complicated by atrial fibrillation: mechanistic, prognostic, and therapeutic implications. J. Cardiovasc. Pharmacol. Ther. 2003;8(2):107-13. DOI: 10.1177/107424840300800203
23. Oudot A., Vergely C., Ecarnot-Laubriet A., Rochette L. Angiotensin II activates NADPH oxidase in isolated rat hearts subjected to ischaemia-reperfusion. Eur. J. Pharmacol. 2003;462(1-3):145-54. DOI: 10.1016/s0014-2999(03)01315-3
24. Wachtell K., Lehto M., Gerdts E., Olsen M.H., Hornestam B., Dahlöf B. et al. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. J. Am. Coll. Cardiol. 2005;45(5):712-9. DOI: 10.1016/j.jacc.2004.10.068
25. Schmieder R.E., Kjeldsen S.E., Julius S., McInnes G.T., Zanchetti A., Hua T.A. et al. Reduced incidence of new-onset atrial fibrillation with angiotensin II receptor blockade: the VALUE trial. J. Hypertens. 2008;26(3):403-11. DOI: 10.1097/HJH.0b013e3282f35c67
26. Tatarsky B.A., Kazyonova N.V., Serebryakov N.V. Direct renin inhibitor in the treatment of paroxysmal atrial fibrillation. Arterial'naya Gipertenziya (Arterial Hypertension). 2010;16(1):74-81. (In Russian). DOI: 10.18705/1607-419X-2010-16-1-74-81
27. Hansson L., Lindholm L.H., Niskanen L., Lanke J., Hedner T., Niklason A. et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet. 1999;353(9153):611-6. DOI: 10.1016/s0140-6736(98)05012-0
28. Hansson L., Lindholm L.H., Ekbom T., Dahlöf B., Lanke J., Sclierstcn B. et al. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet. 1999;354(9192):1751-6. DOI: 10.1016/s0140-6736(99)10327-1
29. Salehian O., Healey J., Stambler B., Alnemer K., Almerri K., Grover J. et al. Impact of ramipril on the incidence of atrial fibrillation: results of the Heart Outcomes Prevention Evaluation study. Am. Heart J. 2007;154(3):448-53. DOI: 10.1016/j.ahj.2007.04.062
30. Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) Investigators; Yusuf S., Teo K., Anderson C., Pogue J., Dyal L., et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomised controlled trial. Lancet. 2008;372(9644):1174-83. DOI: 10.1016/S0140-6736(08)61242-8
31. ONTARGET Investigators; Yusuf S., Teo K.K., Pogue J., Dyal L., Copland I. et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. 2008;358(15):1547-59. DOI: 10.1056/NEJMoa0801317
32. GISSI-AF Investigators; Disertori M., Latini R., Barlera S., Franzosi M.G., Staszewsky L. et al. Valsartan for prevention of recurrent atrial fibrillation. N. Engl. J. Med. 2009;360(22):2379. DOI: 10.1056/NEJMoa0805710
33. Kudryashov S.K., Kanishchev Yu.N., Putkov S.B., Esaulenko N.B., Karpov V.O., Ovcharenko V.P., et al. Instructions for conducting the pre-analytical stage (procedure for taking, storing, and transporting) with biomaterial for laboratory research at the Clinical Laboratory Diagnostics Center of the N.N. Burdenko Military Medical Academy. Moscow. Eco-Press. 2016:220. (In Russian). ISBN: 978-5-90651938-2. EDN: YLFVVZ.
34. Wozakowska-Kaplon B., Bartkowiak R., Janiszewska G. A decrease in serum aldosterone level is associated with maintenance of sinus rhythm after successful cardioversion of atrial fibrillation. Pacing Clin. Electrophysiol. 2010;33(5):561-5. DOI: 10.1111/j.1540-8159.2009.02673
35. Avanesyan G.A., Filatov A.G. Biophysical aspects of myocardial tissue ablation in the treatment of patients with atrial fibrillation. Annaly Aritmologii (Annals of Arrhythmology). 2022;19(1):23-31. (In Russian). DOI: 10.15275/annaritmol.2022.1.4
36. Krijthe B.P., Heeringa J., Kors J.A., Hofman A., Franco O.H., Witteman J.C. et al. Serum potassium levels and the risk of atrial fibrillation: the Rotterdam Study. J. Cardiol. 2013;168(6):5411-5. DOI: 10.1016/j.ijcard.2013.08.048
37. Farah R., Nassar M., Aboraya B., Nseir W. Low serum potassium levels are associated with the risk of atrial fibrillation. Acta Cardiol. 2021;76(8):887-890. DOI: 10.1080/00015385.2020.1799573
38. Tatarintseva Z.G., Kosmacheva E.D., Babicheva O.V. Influence of blood electrolyte levels on the risk of atrial fibrillation after cardiac surgery. Russian Journal of Cardiology. 2024;29(3):5585. (In Russian). DOI: 10.15829/1560-4071-20245585
39. Hagengaard L., S0gaard P., Espersen M., Sessa M., Lund P.E., Krogager M.L. et al. Association between serum potassium levels and short-term mortality in patients with atrial fibrillation or flutter co-treated with diuretics and rate- or rhythm-controlling drugs. Eur. Heart J. Cardiovasc. Pharmacother. 2020;6(3):137-144. DOI: 10.1093/ehjcvp/pvz024
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For citations:
Bobyleva T.A., Tkachenko S.B., Kazakov S.P., Putkov S.B. Analysis of the renin-angiotensin-aldosterone system in men with hypertension and atrial fibrillation. Clinical Medicine (Russian Journal). 2025;103(10-11):753-759. (In Russ.) https://doi.org/10.30629/0023-2149-2025-103-10-11-753-759
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