Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid-60s: Data From the ACE 1950 Study

Peter Selmer Rønningen, Trygve Berge, Magnar Gangås Solberg, Steve Enger, Mohammad Osman Pervez, Eivind Bjørkan Orstad, Brede Kvisvik, Erika Nerdrum Aagaard, Magnus Nakrem Lyngbakken, Inger Ariansen, Helge Røsjø, Kjetil Steine, Arnljot Tveit, Peter Selmer Rønningen, Trygve Berge, Magnar Gangås Solberg, Steve Enger, Mohammad Osman Pervez, Eivind Bjørkan Orstad, Brede Kvisvik, Erika Nerdrum Aagaard, Magnus Nakrem Lyngbakken, Inger Ariansen, Helge Røsjø, Kjetil Steine, Arnljot Tveit

Abstract

Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid-60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end-systolic volume was 0.09 mL (95% CI, 0.04-0.14 mL) larger per 1-mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.

Keywords: echocardiography; high blood pressure; hypertension; left atrium; remodeling.

Figures

Figure 1. Flowchart of the study population.
Figure 1. Flowchart of the study population.
ACE 1950 Study indicates Akershus Cardiac Examination 1950 Study.
Figure 2. Scatterplot of systolic blood pressure…
Figure 2. Scatterplot of systolic blood pressure at ages 40 to 43 years (x axis) and left atrial maximum volume (LAVmax) at ages 62 to 65 years (y axis), by sex.
Fitted linear regression line: y=20.85+0.24 x, with R2=0.04.
Figure 3. Receiver operating characteristic (ROC) curve…
Figure 3. Receiver operating characteristic (ROC) curve indicating the ability of systolic blood pressure as a continuous variable at ages 40 to 43 years to predict participants that developed left atrial enlargement (LAVimax>34 mL/m2) at ages 62 to 65 years.
Area under the curve, 0.58 (95% CI, 0.54–0.61; P<0.001). LAVimax indicates left atrial end‐systolic volume indexed to body surface area.

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