Increased pulse pressure is associated with left atrial enlargement in resistant hypertensive patients

Abstract

Resistant hypertension (RH) is frequently associated with a high prevalence of target organ damage, which impairs the prognosis of these patients. Considering cardiac alterations in RH, most attention has been devoted to left ventricular hypertrophy (LVH), but data concerning left atrial enlargement (LAE) is less known. This cross-sectional study assessed the factors associated with LAE, with special focus on blood pressure (BP) estimates obtained by ambulatory blood pressure monitoring (ABPM), in 250 patients with RH, aged 64 ± 11 years. LAE and LVH were observed in 10.0% (95% CI 6.3–13.7) and 57.1% (95% CI 50.8–63.5) of patients, respectively. Compared with patients with normal atrium size, those exhibiting LAE were older, more frequently women, had elevated pulse pressure (PP) measured both at the office and by ABPM, and showed higher prevalence of LVH (83% vs 54%; p = 0.016). In a logistic regression analysis, adjusting for age, gender, body mass index, left ventricular mass index and BP pressure estimates, night-time PP was independently associated with LAE (OR for 5 mmHg = 1.28, 95% CI 1.24–1.32; p = 0.001). In conclusion, besides classical determinants of LAE, such as age and LVH, an elevated night-time PP was independently associated with LAE in patients with RH.

Key Words::

• Ambulatory blood pressure monitoring
• left atrial enlargement
• pulse pressure
• resistant hypertension

Acknowledgements

We thank the Statistical support of the senior biostatistician, Marta Figueras Balsells from TFS Spain.

Sources of funding

The Spanish Resistant Hypertension Registry is funded by Novartis Pharmaceuticals.

Conflict of interest: The Spanish Resistant Hypertension Registry is funded by Novartis Pharmaceuticals. Pedro Armario has received honoraria for development of educational presentation from Menarin. Anna Oliveras has received honoraria for development of educational presentation from Menarini. Alejandro de la Sierra has received honoraria for lectures from Daiichi-Sankyo, Novartis and Merck Sharp & Dohme and honoraria for development of educational presentations from Menarini. Luis M Ruilope has received honoraria for lectures or advisory from Bayer, Sanofi-Aventis, Takeda, Daiichi-Sankyo, Otsuka, Relypsa, Roche, oehringer-Ingelheim, Novartis, Astra-Zeneka, and BMS and fees for lectures and participation in reviews activities and development of educational presentations. The remaining authors declare that they have no conflict of interest.

Investigators of the Spanish Society of Hypertension-Resistant Hypertension Registry

Scientific Committee

Pedro Aranda, Pedro Armario, Carlos Calvo, Juan Antonio Divisón, Pablo Gómez, Raquel Hernández del Rey, Anna Oliveras, Alejandro Roca-Cusachs, Luis M. Ruilope, Carlos Sanchís, Julián Segura, Alejandro de la Sierra, Carmen Suárez.

Investigators

María Abad, María Jesús Adrián, Javier Andrés, Pedro Armario, Jesús María Arteaga, Mario Luis Ávila, Sonia Blanco, Josep Bonet, Carlos Calvo, Mari Cruz Carreño, Eva María Cotilla, Luis Miguel Cuadrado, Alejandro de la Sierra, Leyre Díez, Juan Antonio Divisón, Mónica Doménech, María Jesús Eiris, Vicente Esteve, Angela Felip, Gema Fernández-Fresnedo, Patrícia Fernández-Llama, Celia Fernández, José Antonio García, Vicente Giner, Pablo Gómez, Javier Guerediaga, Fernando Gutiérrez, Raquel Hernández-del Rey, Pedro Horcajo, Julio Jorge, Pedro Jesús Labrador, Ignacio Lekuona, Antonio Liébana, María Dolores López, Dolores Lorenzo, Antonia Maldonado, María José Manzanera, Nieves Martell-Clarós, Jesús Martín, Isabel Martínez, Juan Carlos Martínez-Acitores, Carmen Morata, Anna Oliveras, Manuel Olmos, Aitor Parra, José Manuel Pascual, Antonio Pedreira, Gonzalo Pia, Mar Piedecausa, Luis Angel Prieto, José Neldo Prieto, Josep Redón, Nicolás Roberto Robles, Alejandro Roca-Cusachs, Jordi Roig, Eduardo Rovira, José Saban, Juan Francisco Sánchez, Pilar Sánchez, Julián Segura, Javier Sobrino, Carmen Suárez, Javier Tisaire, Pere Torguet, Jesús Toril, Santiago Torreira, Susana Vázquez, Ana Veiga, Luis Vigil, José Ovidio Yáñez.