Published Online
on December 18, 2006

A more recent version of this article appeared on February 1, 2007

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Submitted on July 28, 2006
Revised on August 21, 2006

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

Eva Gerdts^*; Kristian Wachtell; Per Omvik; Jan Erik Otterstad; Lasse Oikarinen; Kurt Boman; Björn Dahlöf; and Richard B. Devereux

From the Institute of Medicine (E.G., P.O.), University of Bergen, Bergen, Norway; the Department of Medicine (K.W.), Copenhagen County University Hospital, Glostrup, Denmark; the Department of Medicine (J.E.O.), Vestfold Central Hospital, Tönsberg, Norway; the Department of Cardiology (L.O.), Helsinki University Central Hospital, Helsinki, Finland; the Department of Medicine (K.B.), Skellefteå Hospital and Umeå University, Skellefteå, Sweden; the Department of Medicine (B.D.), Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; and the Department of Medicine (R.B.D.), Weill Medical College of Cornell University, New York, NY.

^* To whom correspondence should be addressed. E-mail: gerdtsev{at}online.no.

Abstract--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 (mean: 66) 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 ratio: 1.98 per cm/m [95% CI: 1.02 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<0.001) in multiple linear regression, adjusting for baseline left atrial diameter/height. However, in time-varying Cox regression analysis, left atrial diameter reduction was not independent of left ventricular hypertrophy regression in predicting cardiovascular events during follow-up. In conclusion, left atrial diameter/height predicts risk of cardiovascular events independent of other clinical risk factors in hypertensive patients with left ventricular hypertrophy and may be useful in pretreatment clinical assessment of cardiovascular risk in these patients.

Key words: cardiovascular events • hypertension • left atrium • left ventricular hypertrophy

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