title: Effects of renin-angiotensin system inhibition on left atrial function of hypertensive patients: an echocardiographic tissue deformation imaging study.
abstract: BACKGROUND
  Although renin-angiotensin system (RAS) inhibitors have beneficial effects on left ventricular myocardium, their effect on left atrial (LA) function remains unknown. The aim of this study was to evaluate the effect of treatment with RAS inhibitors on LA function of patients with essential hypertension.
  
  
  METHODS
  Forty hypertensive patients (17 males, mean age 47.1 +/- 1.5, mean blood pressure 158.3 +/- 1.8/97.1 +/- 0.7 mm Hg) were studied using LA strain and strain rate (SR) imaging before and after 9 months of treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
  
  
  RESULTS
  Standard echocardiographic parameters of LA function (LA volumes, ejection fraction, active and passive emptying fraction, and ejection force), as well as left ventricular diastolic indexes did not change with RAS-blocking treatment. However, peak systolic LA strain and SR were significantly higher at study end compared to baseline (77.8 +/- 5.2% vs. 63.3 +/- 4.1%, P < 0.001 and 3.9 +/- 0.2 s(-1) vs. 3.1 +/- 0.2 s(-1), P < 0.0001, respectively). No correlation was found between changes in systolic or diastolic blood pressure, and changes in strain or SR change during treatment.
  
  
  CONCLUSIONS
  LA strain and SR imaging improved after reduction of blood pressure with RAS inhibitors in hypertensive patients, whereas standard LA echocardiographic parameters remained unchanged. LA strain/SR values may have a role in detecting subclinical myocardial involvement in essential hypertension at an early stage; the association between change in these indexes after antihypertensive treatment and clinical outcome merits further evaluation.
authors.affiliation: First Propaedeutic Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Hariklia
authors.initials: H
authors.lastname: Dimitroula
authors.forename: Efthalia
authors.initials: E
authors.lastname: Damvopoulou
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannakoulas
authors.forename: Emmanouella
authors.initials: E
authors.lastname: Dalamanga
authors.forename: Theodoros
authors.initials: T
authors.lastname: Dimitroulas
authors.forename: Pantelis A
authors.initials: PA
authors.lastname: Sarafidis
authors.forename: Haralambos
authors.initials: H
authors.lastname: Styliadis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Hatzitolios
authors.forename: Haralambos
authors.initials: H
authors.lastname: Karvounis
authors.forename: Georgios
authors.initials: G
authors.lastname: Parcharidis
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D016279:Atrial Function, Left / Q000187:drug effects* / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors