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Atrial Dilatation Development in Hypertensive Treated Patients: The Campania-Salute Network
Maria-Angela Losi1, Raffaele Izzo2, Grazia Canciello1
1Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy;
Insights
Left atrial dilatation in hypertension is linked to older age, female sex, obesity, and higher LV mass. Diuretic use may protect against this condition.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Left atrial (LA) dilatation is a known predictor of adverse outcomes in hypertensive patients.
- Limited data exist on the clinical, demographic, and echocardiographic factors associated with LA dilatation development in hypertension.
Purpose of the Study:
- To identify clinical, demographic, and echocardiographic predictors of left atrial dilatation in hypertensive individuals.
- To investigate potential protective factors against the development of left atrial dilatation.
Main Methods:
- Analysis of 5,375 hypertensive patients from the Campania-Salute Network registry with normal LA diameter and left ventricular ejection fraction.
- Echocardiographic follow-up of at least 12 months, with clinical evaluation including antihypertensive drug types.
- Cox regression analysis to determine factors associated with incident LA dilatation.
Main Results:
- Over a median follow-up of 70 months, 12% of patients developed LA dilatation.
- Incident LA dilatation was associated with older age, female gender, obesity, diabetes, higher LV mass, concentric LV geometry, and impaired diastolic function (lower E/A ratio, longer E deceleration time).
- Diuretic use was found to be protective against LA dilatation.
Conclusions:
- A distinct risk profile for LA dilatation in hypertension includes older age, female sex, obesity, higher LV mass, and worse diastolic function.
- Diuretic therapy may play a protective role in preventing LA dilatation in this patient subgroup.
Background:
Left atrial (LA) dilatation is associated with unfavorable outcome in hypertension. However, there are few data on clinical, demographic, and echocardiographic findings correlated with LA dilatation development.
Methods:
From the Campania-Salute Network registry, we identified 5,375 hypertensive patients (52±11 years, 38% women) in normal sinus rhythm, with normal LA diameter (parasternal short-axis <24.0 in women and <25.4mm/m in men), with normal left ventricular (LV) ejection fraction, and with at least 12 months of echocardiographic follow-up. We included in the clinic evaluation type of antihypertensive drugs.
Results:
Follow-up duration was of 70±48 months. During follow-up, 647 patients (12%) showed LA dilatation. Patients with incident LA dilatation were older, most likely to be women, more obese, more diabetics, with lower Modification of Diet in Renal Disease, higher total cholesterol, lower uric acid, higher pulse pressure, lower heart rate, higher LV mass, concentric geometry and lower E/A ratio at mitral level, longer E deceleration time, and higher intima-media carotid thickness. They take more drugs, and follow-up was longer (overall P < 0.05). In the Cox analysis, age, female gender, obesity, higher LV mass, LA diameter at baseline, and longer E deceleration time were determinants of LA dilatation. Furthermore, the use of diuretics protected against LA dilatation.
Conclusions:
Our data identify a risk profile for LA dilatation, characterized by older age, female sex, obesity, higher LV mass, and worse diastolic function. In this subgroup of patients, the use of diuretics seems to protect against LA dilatation.