From the Cooperative Studies Program of the Department of Veterans
Affairs Research and Development Service and the Division of Cardiology,
Georgetown University Medical Center, Washington, DC.
Correspondence to John S. Gottdiener, MD, Cardiology Division–M 4219, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007. E-mail gottdien{at}ziplink.net
Background—Cardiac effects of
hypertension include increased left ventricular (LV) mass
and LV hypertrophy, as well as increased left atrial size,
a predictor of stroke and atrial fibrillation. Although literature on
reduction of LV mass with antihypertensive therapy is extensive, little
information is available on effects of treatment on left atrial
size.
Methods and Results—Patients with mild to moderate hypertension
(diastolic blood pressure 95 to 109 mm Hg) were
randomly allocated to treatment with atenolol, captopril, clonidine,
diltiazem, hydrochlorothiazide, or prazosin in a
double-masked trial. Two-dimensional targeted M-mode
echocardiography was used to assess left atrial
size and LV mass at baseline, 8 weeks, and 1 and 2 years. Longitudinal
analysis examined changes in left atrial size from the baseline
study, statistically adjusting for age, race, pretreatment left atrial
size and LV mass, and serial measurements of systolic blood
pressure, body weight, urinary sodium excretion, and physical activity
score. Without adjustment for covariates, only
hydrochlorothiazide was associated with decreases in
left atrial size from baseline at 8 weeks (-1.0±5.2 mm;
P=0.052), 1 year (-2.0±5.1 mm;
P=0.02), and 2 years (4.6±7.2 mm;
P=0.002). After adjustment for effects of covariates,
patients with normal left atrial size had greater reduction (-3.3
mm) in left atrial size at 2 years with
hydrochlorothiazide than with any other drug. For
patients with left atrial enlargement, left atrial size decreased
significantly with hydrochlorothiazide, atenolol,
clonidine, and diltiazem at 1 year and with all treatments at 2 years.
However, reduction at 2 years was greater with
hydrochlorothiazide than with captopril or
prazosin.
Conclusions—Antihypertensive drugs differ in their effects on
left atrial size. Hydrochlorothiazide was associated
with greater overall reduction of left atrial size than other drugs
effective for the treatment of hypertension. Reduction of left atrial
size with therapy is in part independent of factors known to influence
left atrial size, including LV mass and reduction of LV mass with
treatment. The clinical benefit of reducing left atrial size with
antihypertensive treatment remains to be determined.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Effect of Single-Drug Therapy on Reduction of Left Atrial Size in Mild to Moderate Hypertension
Comparison of Six Antihypertensive Agents
Key Words: hypertension • drugs • atrium
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