Abstract 9912: Impact of Blood Pressure Lowering Therapy on Left Atrial Function and the Incidence of Atrial Fibrillation in Elderly Hypertensive Patients: Results from a Prospective Study with Speckle Tracking Echocardiography
Background: The risk of atrial fibrillation (AF) associated with left atrial (LA) remodeling is increasing in elderly patients with hypertension (HTN). We assessed the hypothesis that strict blood pressure (BP) lowering therapy has a beneficial effect on LA structure and function and may decrease the incidence of new-onset AF in elderly patients with HTN.
Methods: First, we recruited 380 patients ≥65 years old with HTN. Exclusion criteria were secondary HTN, atrial arrhythmias, systolic dysfunction (left ventricular ejection fraction <50%), congestive heart failure or myocardial infarction or stroke within the past six months, moderate to sever valvular disease. We divided 234 subjects ≥65 years old, (75±5 years old) into four groups based on mean office BP achieved over the past two years and followed up for two years: a normotensive group (n=71), a HTN group with good BP control (systolic BP <130 and diastolic BP <80 mmHg, n=72), a HTN group with poor BP control (systolic BP ≥140 or diastolic BP ≥90 mmHg, n=41) and a HTN group with moderate BP control (systolic BP ≥ 130 but <140 and diastolic BP <90 or systolic BP <140 mmHg and diastolic BP <90 but ≥80 mmHg, n=50). LA volume, emptying function (EF), strain and strain rate (SR) were measured by speckle tracking echocardiography at baseline and after two years.
Results: 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 at baseline and after two years. The incidence of new-onset AF during two years was significantly higher in the HTN group with poor BP control (hazard ratio: 7.015 (95% CI: 2.433 - 20.22), p<0.001).
Conclusion: LA structure and function were preserved in the HTN group with good BP control, and this was associated with preserved diastolic function and comparable to normal. Strict BP lowering therapy had a beneficial effect on LA structure and function and should be recommended to prevent new-onset AF even in elderly HTN patients.
- © 2012 by American Heart Association, Inc.