Evolution of left atrial systolic and diastolic functions in different stages of hypertension: distinct effects of blood pressure control.
BACKGROUND
To evaluate the left atrial (LA) volume, and LA systolic (contractile) and diastolic (expansion) functions in different stages of hypertension with or without atrial fibrillation (AF), as well as the effects of good blood pressure control.


METHODS
A prospective observational study. Individuals including 22 normotensive controls, 23 patients with mild hypertension, 20 with severe hypertension, and 17 with hypertension and paroxysmal AF were recruited for paired echocardiography studies at baseline and 6 months after control of hypertension.


RESULTS
With increasing severity of hypertension, left ventricular (LV) diastolic function deteriorated with decreasing LV septal E'/A' and increasing E/E' ratios. LA expansion index was reduced in parallel. LA expansion index was correlated positively with LV E'/A' (r = 0.43, p = 0.022) and inversely with LV E/E' (r = 0.49, p = 0.009). Significant improvement of LV diastolic function and LA expansion index preceded the reduction of LA volume after blood pressure control. In patients with paroxysmal AF, LA volume reduction was more evident in patients receiving angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers.


CONCLUSIONS
With progressive LV diastolic dysfunction in hypertension, there was a corresponding deterioration in LA diastolic function. Effective blood pressure control for 6 months improved LA diastolic function.
Division of Cardiology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan, ROC.
Chia-Ti
CT
Tsai
Juey-Jen
JJ
Hwang
Yi-Chung
YC
Shih
Fu-Tien
FT
Chiang
Ling-Ping
LP
Lai
Jiunn-Lee
JL
Lin
D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003971:Diastole; D018450:Disease Progression; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
D000959:Antihypertensive Agents