Association among blood pressure control in elderly patients with hypertension, left atrial structure and function and new-onset atrial fibrillation: a prospective 2-year study in 234 patients

Abstract

We assessed the hypothesis that blood pressure (BP)-lowering therapy has a beneficial effect on left atrial (LA) structure and function and may decrease the incidence of new-onset atrial fibrillation (AF) in elderly patients with hypertension (HTN). We divided 234 subjects ≥65 years old into four groups based on mean office BP achieved: a normotensive group (n=71), a HTN group with good BP control (n=72), a HTN group with poor BP control (n=41) and a HTN group with moderate BP control (n=50). LA volume, emptying function (EF), strain and strain rate (SR) were measured by speckle tracking echocardiography. LA volume, EF, strain and SR in the HTN group with good BP control were better preserved than those parameters in the HTN group with poor BP control. The incidence of new-onset AF during 2 years was significantly higher in the HTN group with poor BP control (hazard ratio: 7.015; 95% confidence interval: 2.433-20.22; P<0.001). In multivariate Cox regression analysis that included the difference in echocardiographic parameters between baseline and follow-up, both age and being in the HTN group with poor BP control were independent predictors of new-onset AF. In multivariate Cox regression analysis that included only parameters at baseline, ratio of the peak early transmitral flow velocity (E) to the peak early myocardial tissue velocity (E/e') was an independent predictor of new-onset AF. The incidence of new-onset AF depended on the long-term level of BP control rather than short-term changes in LA structure and function. Poor BP control increased the risk of new-onset AF in elderly patients with HTN.

Eplerenone might affect atrial fibrosis in patients with hypertension

“…In their study, LA volume, emptying function, strain, and strain rate were measured by speckle tracking echocardiography. However, those parameters were not associated with new‐onset AF . On the other hand, as previously reported, P‐SAECG was useful to detect new‐onset AF …”

Association of left atrial enlargement with ventricular remodeling in hypertensive Chinese elderly

“…21 Left atrial enlargement reflects LV concentric hypertrophy and diastolic dysfunction [22][23][24][25][26] ; and it is also closely related to LV eccentric hypertrophy and systolic dysfunction in patients with essential hypertension, 10 which can further increase LV end-diastolic filling pressure and LA size. 10,27 A previous study reported that LA enlargement was associated with RV concentric hypertrophy. 28 To our own knowledge, this study shows for the first time that LA enlargement might reflect a longer du- T A B L E 3 Multivariable adjusted parameters associated with LA diameter in hypertensive elderly with preserved LVEF F I G U R E 1 The independent correlation of left atrial diameter with hypertension duration and right ventricular diameter in hypertensive elderly with preserved ejection fraction…”

“…Left atrial enlargement reflects LV concentric hypertrophy and diastolic dysfunction; and it is also closely related to LV eccentric hypertrophy and systolic dysfunction in patients with essential hypertension, which can further increase LV end‐diastolic filling pressure and LA size …”

“…As LA enlargement was found to be associated with RV eccentric hypertrophy even in the relatively early stages of hypertension in this study, it might be used as a marker for early identification of RV eccentric remodeling in elderly patients with hypertension. These proposed results may be useful for initiating early interventional measures including a control of elevated blood pressure to prevent the eccentric hypertensive cardiomyopathy …”

Impact of pre‐existing hypertension and control status before atrial fibrillation onset on cardiovascular prognosis in patients with non‐valvular atrial fibrillation: A real‐world database analysis in Japan

“…Poor control of blood pressure (BP) in elderly patients with hypertension has been associated with a significantly higher incidence of new‐onset AF compared with normotensives or patients with hypertension who had good or moderate BP control (hazard ratio [HR] 7.0, 95% confidence interval [CI] 2.4‐20.2; P < .001), although BP levels may be underestimated in patients with AF . Furthermore, data from a large systematic review showed that antihypertensive therapy with angiotensin receptor blockers tended to reduce the rate of new‐onset AF in patients with hypertension (odds ratio [OR] 0.85, 95% CI 0.71‐1.01; P = .067) .…”