Left Atrial Size and Risk of Major Cardiovascular Events During Antihypertensive Treatment: Losartan Intervention for Endpoint Reduction in Hypertension Trial

• Published in: Hypertension (Dallas, Tex. 1979) Tex. 1979), 2007-02, Vol.49 (2), p.311-316
• Main Authors: Gerdts, Eva, Wachtell, Kristian, Omvik, Per, Otterstad, Jan Erik, Oikarinen, Lasse, Boman, Kurt, Dahlöf, Björn, Devereux, Richard B
• Format: Article
• Language: English
• Subjects: 80 and over; Aged; Aged, 80 and over; Antihypertensive agents; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Atenolol - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cardiovascular Diseases/etiology/mortality; Cardiovascular system; Cerebrovascular Accident/epidemiology/etiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Doppler; Echocardiography; Echocardiography, Doppler; Female; Follow-Up Studies; Heart Atria; Humans; Hypertension - complications; Hypertension - diagnostic imaging; Hypertension - drug therapy; Hypertension/complications/drug therapy/ultrasonography; Hypertrophy; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - etiology; Incidence; Left Ventricular/etiology/ultrasonography; Losartan - therapeutic use; Male; MEDICAL AND HEALTH SCIENCES; Medical sciences; MEDICIN OCH HÄLSOVETENSKAP; Middle Aged; Pharmacology. Drug treatments; Predictive Value of Tests; Risk Assessment; Stroke - epidemiology; Stroke - etiology
• ISSN: 0194-911X; 1524-4563; 1524-4563
• DOI: 10.1161/01.HYP.0000254322.96189.85

The influence of left atrial size on cardiovascular events during antihypertensive treatment has not been reported previously from a long-term, prospective, randomized hypertension treatment trial. We recorded left atrial diameter by annual echocardiography and cardiovascular events in 881 hypertensive patients (41% women) with electrocardiographic left ventricular hypertrophy aged 55 to 80 (mean66) years during a mean of 4.8 years of randomized losartan- or atenolol-based treatment in the Losartan Intervention for Endpoint Reduction in Hypertension Study. During follow-up, a total of 88 primary end points (combined cardiovascular death, myocardial infarction, or stroke) occurred. In Cox regression, baseline left atrial diameter/height predicted incidence of cardiovascular events (hazard ratio1.98 per cm/m [95% CI1.02 to 3.83 per cm/m]; P=0.042) adjusted for significant effects of Framingham risk score and history of atrial fibrillation. Greater left atrial diameter reduction during follow-up was associated with greater reduction in left ventricular hypertrophy, absence of new-onset atrial fibrillation or mitral regurgitation during follow-up, and losartan-based treatment (B=−0.13±0.03 cm/m; P