Document Detail

In-treatment reduced left atrial diameter during antihypertensive treatment is associated with reduced new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy: The LIFE Study.
MedLine Citation:
PMID:  20438307     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: It is unclear whether improvement of left atrial (LA) and ventricular (LV) structure results in reduction in new-onset atrial fibrillation (AF). The aim of the present study was to examine whether changes in-treatment LA diameter were related to changes in risk of new-onset AF. METHODS: We followed 939 hypertensive patients with electrocardiographic LV hypertrophy randomized to atenolol or losartan-based regimens in the LIFE Study for a mean of 4.8 years with echocardiograms at enrolment and annually during treatment. RESULTS: New-onset AF occurred in 46 patients (10.2/1000 patient-years of follow-up). At baseline, patients with new-onset AF were older, had higher systolic blood pressure and heart rate as well as higher prevalence of LA dilatation, but had similar prevalences of LV hypertrophy and mitral or aortic valve disease. In univariate Cox analysis baseline LA diameter (HR=4.67 per cm increase [95% CI 2.86-7.65], p<0.001) and LV mass index (HR=1.11 per 10 g/m(2) increase [95% CI 1.02-1.22], p<0.05) both predicted new-onset AF. In multivariate analysis, increased baseline LA diameter increased the risk of new-onset AF (HR=5.16 per cm [95% CI 2.85-9.35], p<0.001) whereas reduction of in-treatment LA diameter reduced the risk (HR=0.21 per cm lower LA diameter during treatment [95% CI 0.14-0.32], p<0.001) with adjustment for in-treatment LV mass in-treatment systolic blood pressure, age and Framingham risk score. CONCLUSION: LA diameter at baseline and during antihypertensive treatment were equally strong predictors of new-onset AF independent of the level of arterial pressure, LV mass and other covariates. Prevention of AF during antihypertensive treatment may be improved by antihypertensive therapy that reduces LA size in addition to controlling blood pressure.
Kristian Wachtell; Eva Gerdts; Gerard P Aurigemma; Kurt Boman; Björn Dahlöf; Markku S Nieminen; Michael Hecht Olsen; Peter M Okin; Vittorio Palmieri; Jens E Rokkedal; Richard B Devereux
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Blood pressure     Volume:  19     ISSN:  1651-1999     ISO Abbreviation:  Blood Press.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-20     Completed Date:  2010-08-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9301454     Medline TA:  Blood Press     Country:  England    
Other Details:
Languages:  eng     Pagination:  169-75     Citation Subset:  IM    
Department of Cardiology, Rigshospitalet, Denmark.
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MeSH Terms
Antihypertensive Agents / pharmacology,  therapeutic use*
Arrhythmias, Cardiac / complications,  drug therapy
Atenolol / pharmacology,  therapeutic use
Atrial Fibrillation / drug therapy,  epidemiology,  prevention & control*
Blood Pressure / drug effects
Cardiomegaly / complications,  drug therapy
Cardiovascular Diseases / complications,  drug therapy
Heart Atria / physiopathology
Heart Rate
Heart Ventricles / physiopathology
Hypertension / complications,  drug therapy*,  physiopathology
Hypertrophy, Left Ventricular / complications,  drug therapy*,  physiopathology*
Losartan / pharmacology,  therapeutic use
Middle Aged
Reg. No./Substance:
0/Antihypertensive Agents; 114798-26-4/Losartan; 29122-68-7/Atenolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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