Study on the correlation between ambulatory blood pressure and left atrial diameter in patients with treated and controlled office hypertension
Authors: Zhang LIJIAO , Zhang X U , Song W E I , Zhang YING , Jiang YINONG , Qu PENG 
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

  Patients suffered from different kinds of target organ damage even after years of standardized treatment in clinic. 

Purpose

To explore the relationship between ABPM and LAD in patients with treated essential hypertension.

Methods

The study enrolled 347 patients with controlled blood pressure evaluated by clinical standard in the Department of Hypertension from January 2015 to May 2020. The T test was used to compare general data, Cardiac ultrasoundwere used to compare the differences between the two groups. Spearman correlation was used to analyze the correlation between ABPM and heart rate variability and target organ damage.Logistic regression analysis was used to figure out the independent risk factor for LAD abnormity. 

Results

(1)LAD normal group: 153 people; the LAD abnormal group: 194 people. Compared with the LAD normal group, the proportion of males, age,body mass index, duration of hypertension,fasting blood glucose, and glycosylated hemoglobin and the proportion of patients with controlled ABPM were significantly higher in the LAD abnormal group(P &lt; 0.05). The average LAD in abnormal group was significantly lower than the LAD normal group (P &lt; 0.05). RAS inhibitor(ACEI or ARB)usage rate of LAD normal group is significantly higher than LAD abnormal group(P &lt; 0.05). On the contrary the usage rate of diuretic of the LAD normal group is lower than of the LAD abnormal group. (2)Spearman correlation analysis between the average blood pressure of each time period of ABPM and LAD found that LAD are positively correlated with the systolic blood pressure for the whole day（r = 0.141, p = 0.00）, the day time （r = 0.118, p = 0.02）or nocturnal（r = 0.178,=0.001）. However there is a negative correlation between LAD and the percentage of systolic blood pressure drops at night（r = 0.149,=0.005. (3)Through Logistic regression analysis, it was found that BMI(OR: 1.22, 95% CI: 1.125-1.324, P &lt; 0.001),nocturnal average systolic blood pressure(OR: 1.02, 95% CI: 1.003-1.038, P = 0.019）, duration of hypertension (OR: 1.043, 95% CI: 1.01-1.078, P = 0.01;)and diuretic usage (OR: 0.298, 95% CI: 0.138-0.644, P = 0.002)are independent risk factors for LAD .(4) For LAD abnormity, the risk factors mentioned above were identified when the area under the LAD abnormity ROC curve exceeded 80.4 % (P = 0.11, 95% CI: 1.125-1.324, P &lt; 0.001).  

Conclusion

1. Hypertension patients whose office blood pressure reached the standard but with uncontrolled ABPM have significantly suffered form a higher LAD enlargement than those met the standard both in clinic and ABPM. The uncontrolled ABPM is an independent risk factor for LAD. 2. In the 24-hour blood pressure, uncontrolled of SBP by time of day is  positively correlated with LAD. 3. Hypertensive patients whose blood pressure in the office reach the standard  should actively perform ABPM and adjust the treatment plan according to the circadian blood pressure rhythm.