Effect of single-drug therapy on reduction of left atrial size in mild to moderate hypertension

Comparison of six antihypertensive agents

John S. Gottdiener, Domenic J. Reda, David W. Williams, Barry J Materson, William Cushman, Robert J. Anderson

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Background - Cardiac effects of hypertension include increased left ventricular (LV) mass and LV hypertrophy, as well as increased left atrial size, a predictor of stroke and atrial fibrillation. Although literature on reduction of LV mass with antihypertensive therapy is extensive, little information is available on effects of treatment on left atrial size. Methods and Results - Patients with mild to moderate hypertension (diastolic blood pressure 95 to 109 mm Hg) were randomly allocated to treatment with atenolol, captopril, clonidine, diltiazem, hydrochlorothiazide, or prazosin in a double-masked trial. Two-dimensional targeted M-mode echocardiography was used to assess left atrial size and LV mass at baseline, 8 weeks, and 1 and 2 years. Longitudinal analysis examined changes in left atrial size from the baseline study, statistically adjusting for age, race, pretreatment left atrial size and LV mass, and serial measurements of systolic blood pressure, body weight, urinary sodium excretion, and physical activity score. Without adjustment for covariates, only hydrochlorothiazide was associated with decreases in left atrial size from baseline at 8 weeks (-1.0±5.2 mm; P=0.052), 1 year (-2.02±5.1 mm; P=0.02), and 2 years (4.6±7.2 mm; P=0.002). After adjustment for effects of covariates, patients with normal left atrial size had greater reduction (-3.3 mm) in left atrial size at 2 years with hydrochlorothiazide than with any other drug. For patients with left atrial enlargement, left atrial size decreased significantly with hydrochlorothiazide, atenolol, clonidine, and diltiazem at 1 year and with all treatments at 2 years. However, reduction at 2 years was greater with hydrochlorothiazide than with captopril or prazosin. Conclusions - Antihypertensive drugs differ in their effects on left atrial size. Hydrochlorothiazide was associated with greater overall reduction of left atrial size than other drugs effective for the treatment of hypertension. Reduction of left atrial size with therapy is in part independent of factors known to influence left atrial size, including LV mass and reduction of LV mass with treatment. The clinical benefit of reducing left atrial size with antihypertensive treatment remains to be determined.

Original languageEnglish
Pages (from-to)140-148
Number of pages9
JournalCirculation
Volume98
Issue number2
StatePublished - Jul 14 1998
Externally publishedYes

Fingerprint

Antihypertensive Agents
Hydrochlorothiazide
Hypertension
Drug Therapy
Blood Pressure
Atenolol
Diltiazem
Prazosin
Clonidine
Therapeutics
Captopril
Left Ventricular Hypertrophy
Pharmaceutical Preparations
Atrial Fibrillation
Echocardiography
Sodium
Stroke
Body Weight
Exercise

Keywords

  • Atrium
  • Drugs
  • Hypertension

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Gottdiener, J. S., Reda, D. J., Williams, D. W., Materson, B. J., Cushman, W., & Anderson, R. J. (1998). Effect of single-drug therapy on reduction of left atrial size in mild to moderate hypertension: Comparison of six antihypertensive agents. Circulation, 98(2), 140-148.

Effect of single-drug therapy on reduction of left atrial size in mild to moderate hypertension : Comparison of six antihypertensive agents. / Gottdiener, John S.; Reda, Domenic J.; Williams, David W.; Materson, Barry J; Cushman, William; Anderson, Robert J.

In: Circulation, Vol. 98, No. 2, 14.07.1998, p. 140-148.

Research output: Contribution to journalArticle

Gottdiener, JS, Reda, DJ, Williams, DW, Materson, BJ, Cushman, W & Anderson, RJ 1998, 'Effect of single-drug therapy on reduction of left atrial size in mild to moderate hypertension: Comparison of six antihypertensive agents', Circulation, vol. 98, no. 2, pp. 140-148.
Gottdiener JS, Reda DJ, Williams DW, Materson BJ, Cushman W, Anderson RJ. Effect of single-drug therapy on reduction of left atrial size in mild to moderate hypertension: Comparison of six antihypertensive agents. Circulation. 1998 Jul 14;98(2):140-148.
Gottdiener, John S. ; Reda, Domenic J. ; Williams, David W. ; Materson, Barry J ; Cushman, William ; Anderson, Robert J. / Effect of single-drug therapy on reduction of left atrial size in mild to moderate hypertension : Comparison of six antihypertensive agents. In: Circulation. 1998 ; Vol. 98, No. 2. pp. 140-148.
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N2 - Background - Cardiac effects of hypertension include increased left ventricular (LV) mass and LV hypertrophy, as well as increased left atrial size, a predictor of stroke and atrial fibrillation. Although literature on reduction of LV mass with antihypertensive therapy is extensive, little information is available on effects of treatment on left atrial size. Methods and Results - Patients with mild to moderate hypertension (diastolic blood pressure 95 to 109 mm Hg) were randomly allocated to treatment with atenolol, captopril, clonidine, diltiazem, hydrochlorothiazide, or prazosin in a double-masked trial. Two-dimensional targeted M-mode echocardiography was used to assess left atrial size and LV mass at baseline, 8 weeks, and 1 and 2 years. Longitudinal analysis examined changes in left atrial size from the baseline study, statistically adjusting for age, race, pretreatment left atrial size and LV mass, and serial measurements of systolic blood pressure, body weight, urinary sodium excretion, and physical activity score. Without adjustment for covariates, only hydrochlorothiazide was associated with decreases in left atrial size from baseline at 8 weeks (-1.0±5.2 mm; P=0.052), 1 year (-2.02±5.1 mm; P=0.02), and 2 years (4.6±7.2 mm; P=0.002). After adjustment for effects of covariates, patients with normal left atrial size had greater reduction (-3.3 mm) in left atrial size at 2 years with hydrochlorothiazide than with any other drug. For patients with left atrial enlargement, left atrial size decreased significantly with hydrochlorothiazide, atenolol, clonidine, and diltiazem at 1 year and with all treatments at 2 years. However, reduction at 2 years was greater with hydrochlorothiazide than with captopril or prazosin. Conclusions - Antihypertensive drugs differ in their effects on left atrial size. Hydrochlorothiazide was associated with greater overall reduction of left atrial size than other drugs effective for the treatment of hypertension. Reduction of left atrial size with therapy is in part independent of factors known to influence left atrial size, including LV mass and reduction of LV mass with treatment. The clinical benefit of reducing left atrial size with antihypertensive treatment remains to be determined.

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