The relationship between blood pressure variability, obesity and left atrial phasic function in hypertensive population

Abstract

We sought to investigate the relationship between blood pressure (BP) variability and left atrial (LA) phasic function assessed by volumetric and speckle tracking method in normal-weight, overweight and obese hypertensive patients. This cross-sectional study included 164 untreated hypertensive subjects who underwent a 24-h ambulatory BP monitoring and complete two-dimensional echocardiographic examination (2DE). All the patients were separated into three groups according to their body mass index (BMI): normal-weight patients (BMI < 25 kg/m(2)), overweight patients (25 ≤ BMI < 30 kg/m(2)), and obese patients (BMI ≥ 30 kg/m(2)). Daytime, nighttime and 24 h BP variability indices were higher in obese hypertensive subjects than in lean patients. Maximum and minimum LA volumes and volume indexes gradually and significantly increased, whereas pre-A LAV decreased, from normal-weight to obese subjects. Total and passive LA emptying fractions, representing LA reservoir and conduit function, gradually reduced from lean to obese individuals. Active LA EF, the parameter of LA booster pump function, increased in the same direction. Similar results were obtained by 2DE strain analysis. BP variability parameters were associated with structural, functional and mechanical parameters of LA remodeling in the whole study population. The parameters of LA reservoir function were negatively related with BP variability indices, whereas the parameters of LA pump function were positively related with BP variability indices. Obesity significantly impacts BP variability and LA phasic function in untreated hypertensive subjects. BP variability is associated with LA remodeling independent of BP, left ventricular systolic and diastolic function.

Hypertensive patients with left ventricular hypertrophy have global left atrial dysfunction and impaired atrio-ventricular coupling

“…However, in clinical practice, we do not routinely assess the different components of LA function, although this is now possible because of advances in noninvasive imaging techniques. Recent studies based on tissue Doppler imaging [9], vector velocity imaging (VVI) [10,11], or speckle tracking imaging (STE) [12][13][14][15][16] assessed LA function in patients with HTN with or without LV hypertrophy. However, literature data concerning LA strains in patients with HTN are conflicting.…”

“…However, literature data concerning LA strains in patients with HTN are conflicting. Left atrial reservoir function has been shown to be reduced [12,13] or normal in patients with LV hypertrophy [10,11], whereas it showed early impairment in some studies of HTN patients without hypertrophy [14][15][16]. LA conduit function has been more consistently shown to be reduced, regardless of LV mass [9][10][11]13,15,16].…”

“…LA conduit function has been more consistently shown to be reduced, regardless of LV mass [9][10][11]13,15,16]. Finally, LA booster pump function has been reported as normal [9,10], increased [11,12,14] or reduced [13]. As opposed to tissue Doppler imaging, STE offers the advantage to be angle independent and unaffected by adjacent structures and tethering of neighbouring segments.…”

Arterial Hypertension in the Presence of Overweight and Obesity. The Capabilities of Amlodipine and Lisinopril Combination. Part 1. Features of the Daily Profile of Blood Pressure and Heart Damage as a Target Organ in Patients With Arterial Hypertension in Combination With Overweight and Obesity

“…У пациентов с ожирени-ем имеется ряд особенностей суточного профиля ар-териального давления (АД) [4][5][6][7][8][9], которые обуслов-ливают повышение сердечно-сосудистого риска.…”

“…Tadic M. с соавт. [5] выяви-ли, что у нелеченных пациентов с АГ (n=164) при на-личии у них ожирения, в отличие от больных с АГ без ожирения, имеют место более высокие значения сред-несуточной, среднедневной и средненочной вариа-бельности. Нами также была выявлена достоверно большая вариабельность систолического АД (САД) в ночное время у больных среднего возраста с нелечен-ной АГ и ожирением, в сравнении с пациентами с АГ без ожирения [6].…”