Abstract 11273: Impact of Intensive Blood Pressure Lowering Therapy on Left Atrial Volume and Function Assessed by Speckle Tracking Echocardiography in Elderly Hypertensive Patients with Preserved Systolic Function
Backbround: The risk of atrial fibrillation associated with left atrial (LA) remodeling is increasing in elderly hypertension (HTN) and LA volume and function have a prognostic importance. However, optimal target blood pressure (BP) for LA in elderly remains unclear. We assessed the hypothesis that intensive BP lowering therapy has a beneficial effect on LA structure and function in elderly HTN.
Methods: We studied 265 subjects with age≥65 yrs, who were divided into 4 groups by mean office BP for 2 years; normal subjects (n=73, 75±5 yrs, 37 men), intensive controlled HTN (BP<130/80mmHg, n=85, 74±4 yrs, 43 men), good controlled HTN (130/80≤BP<140/90, n=64, 74±5 yrs, 38 men) and poor controlled HTN (BP≥140/90, n=43, 75±6 yrs, 23 men). LA total, passive and active emptying function (EF) as a global function, LA strain and strain rate (SR) at systole, early diastole and atrial contraction as a regional function were measured in apical 4-chamber view by speckle tracking. Max. and min. LA volume index by Simpson's method, LV ejection fraction and diastolic function (E/e′) were measured. LA total, passive and active EF were defined as (max. – min. volume) / max. volume, (max. – pre-atrial contraction volume) / max. volume and (pre-atrial contraction — min. volume) / pre-atrial contraction volume.
Results: There was no difference in LV ejection fraction among 4 groups. LA volume, LAEF, LA strain and SR in intensive controlled HTN were more preserved than good or poor controlled HTN and were comparable to normal including diastolic function. Comparisons are shown in the table.
Conclusions: LA structure and LA function such as relaxation, conduit function and contraction were preserved in intensive controlled HTN associated with preserved diastolic function. Intensive BP lowering therapy (systolic BP < 130 and diastolic BP < 80mmHg) had a beneficial effect on LA structure and function and would be recommended to prevent LA remodeling and atrial fibrillation even in elderly HTN.
- © 2010 by American Heart Association, Inc.