Association among blood pressure control in elderly patients with hypertension, left atrial structure and function and new-onset atrial fibrillation: a prospective 2-year study in 234 patients.

We assessed the hypothesis that blood pressure (BP)-lowering therapy has a beneficial effect on left atrial (LA) structure and function and may decrease the incidence of new-onset atrial fibrillation (AF) in elderly patients with hypertension (HTN). We divided 234 subjects ≥65 years old into four groups based on mean office BP achieved: a normotensive group (n=71), a HTN group with good BP control (n=72), a HTN group with poor BP control (n=41) and a HTN group with moderate BP control (n=50). LA volume, emptying function (EF), strain and strain rate (SR) were measured by speckle tracking echocardiography. LA volume, EF, strain and SR in the HTN group with good BP control were better preserved than those parameters in the HTN group with poor BP control. The incidence of new-onset AF during 2 years was significantly higher in the HTN group with poor BP control (hazard ratio: 7.015; 95% confidence interval: 2.433-20.22; P<0.001). In multivariate Cox regression analysis that included the difference in echocardiographic parameters between baseline and follow-up, both age and being in the HTN group with poor BP control were independent predictors of new-onset AF. In multivariate Cox regression analysis that included only parameters at baseline, ratio of the peak early transmitral flow velocity (E) to the peak early myocardial tissue velocity (E/e') was an independent predictor of new-onset AF. The incidence of new-onset AF depended on the long-term level of BP control rather than short-term changes in LA structure and function. Poor BP control increased the risk of new-onset AF in elderly patients with HTN.