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Effect of blood pressure reduction on abnormal left atrial appendage function in untreated systemic hypertensive
1Department of Cardiology, Medical Faculty, Yüzüncü Yil University, Van, Turkey. bilgemehmet@hotmail.com
Insights
Lowering blood pressure through antihypertensive therapy significantly improves left atrial appendage (LAA) function in hypertensive patients. This study shows reduced LAA size and increased emptying velocity after treatment.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Systemic hypertension is a prevalent condition affecting cardiovascular health.
- Left atrial appendage (LAA) dysfunction is associated with increased thromboembolic risk.
- The impact of blood pressure reduction on LAA function in hypertensive patients with preserved left ventricular function is not fully understood.
Purpose of the Study:
- To investigate the effect of antihypertensive therapy on left atrial appendage (LAA) function.
- To assess changes in LAA dimensions and emptying velocity following blood pressure reduction.
- To determine if improved LAA function correlates with blood pressure control in hypertensive individuals.
Main Methods:
- Prospective study involving 24 untreated hypertensive patients with normal left ventricular systolic function.
- Transthoracic and transesophageal echocardiography performed at baseline and 3 months after antihypertensive therapy initiation.
- Analysis of left atrial appendage (LAA) maximal areas and emptying velocity, alongside blood pressure measurements.
Main Results:
- Antihypertensive therapy significantly reduced systolic and diastolic blood pressure (p<0.001).
- Maximal LAA areas decreased significantly (6.3 to 4.6 cm2, p<0.001).
- LAA emptying velocity significantly increased (44 to 60 cm/sec, p<0.001) without changes in heart rate or left ventricular parameters.
Conclusions:
- Reduction in blood pressure via antihypertensive therapy improves left atrial appendage (LAA) function.
- Improved LAA function is characterized by reduced size and enhanced emptying velocity.
- These findings suggest a potential benefit of blood pressure control in mitigating LAA-related cardiovascular risks.
Abstract:
To investigate whether reduction in blood pressure has a beneficial effect on left atrial appendage (LAA) function, the authors evaluated 24 untreated systemic hypertensive patients with normal left ventricular systolic function in sinus rhythm at baseline and at 3 months after initiation of antihypertensive therapy. They performed transthoracic and transesophageal echocardiographic examinations in hypertensive patients before and after treatment of hypertension. Three of the 24 patients had blood pressure that failed to respond to the regimen of antihypertensive therapy and were removed from the analysis. Of the remaining 21 patients, mean systolic and diastolic blood pressures at baseline were 170 +/- 18 and 104 +/- 6 mm Hg, respectively, and fell significantly at 3 months to 141 +/- 10 and 90 +/- 5 mm Hg, respectively, (p<0.001) after initiation of antihypertensive therapy. There was no significant change in heart rate with treatment (baseline 81 +/- 8 and at 3 months 84 +/- 9 beats/min). There was no significant change in left ventricular end-diastolic diameter, left ventricular ejection fraction, left ventricular wall thickness, or left atrial diameter from baseline (49 +/- 4 mm, 58 +/- 5%, 12 +/- 1 mm, and 41 +/- 4 mm, respectively) at 3 months (48 +/- 5 mm, 59 +/- 4%, 12 +/- 1 mm, and 40 +/- 3 mm). The treatment caused a significant reduction in maximal LAA areas (6.3 +/- 1.3 cm2 at baseline, 4.6 +/- 0.7 cm2 at 3 months, p<0.001), with a concomitant increase in LAA emptying velocity (44 +/- 7 cm/sec at baseline, 60 +/- 9 cm/sec at 3 months, p<0.001). In conclusion, these findings suggest that reduction in blood pressure with antihypertensive therapy could improve LAA function in hypertensive patients with normal left ventricular systolic function in sinus rhythm.