Upstream therapy of atrial remodeling may decrease atrial fibrillation and associated thromboembolism. We examined the impact of intensive BP lowering on ECG-defined left atrial abnormalities in the SPRINT. SPRINT was a randomized clinical trial comparing outcomes when a systolic BP of <120 mmHg (standard treatment) was the target. We included SPRINT participants without baseline atrial fibrillation who had a technically interpretable baseline ECG and at least one follow-up ECG. The primary outcome was incident left atrial abnormality, defined as P-wave terminal force in V₁ (PTFV₁) > 4000 μV × ms. Secondary outcomes were regression of the left atrial abnormality and the change in PTFV₁ from baseline across follow-up ECGs. Cox regression was used to examine the associations between treatment assignment and incident left atrial abnormality and its regression. We used linear mixed models to examine the changes in PTFV₁. Of 9361 SPRINT participants, 7738 qualified for this analysis, of whom 5544 did not have baseline left atrial abnormalities. Intensive BP management was not associated with incident left atrial abnormality (HR, 0.96; 95% CI, 0.87–1.07) or regression of the baseline left atrial abnormality (HR, 1.09; 95% CI, 0.98–1.21). The change in PTFV₁ from baseline through follow-up did not differ significantly between treatment groups (difference in μV × ms per year, 6; 95% CI, −67 to 79). Thus, among patients in a randomized clinical trial, we found no difference in the progression or regression of ECG-defined left atrial abnormalities with intensive BP management compared to standard BP management.

心房重构的上游治疗可以减少心房颤动和相关的血栓栓塞。我们检查了强化降压对 SPRINT 中 ECG 定义的左心房异常的影响。SPRINT 是一项随机临床试验，比较了以收缩压 <120 mmHg（标准治疗）为目标时的结果。我们纳入了没有基线心房颤动的 SPRINT 参与者，他们有技术上可解释的基线心电图和至少一份后续心电图。主要结果是发生左心房异常，定义为 P 波终末力 V ₁ (PTFV ₁ ) > 4000 μV × ms。次要结果是左心房异常的消退和 PTFV _1的变化从基线跨后续心电图。Cox 回归用于检查治疗分配与事件左心房异常及其回归之间的关联。我们使用线性混合模型来检查 PTFV ₁的变化。在 9361 名 SPRINT 参与者中，7738 名符合此分析条件，其中 5544 名没有基线左心房异常。强化血压管理与左心房异常事件（HR，0.96；95% CI，0.87-1.07）或基线左心房异常的消退（HR，1.09；95% CI，0.98-1.21）无关。PTFV _1的变化从基线到随访在治疗组之间没有显着差异（每年 μV × ms 的差异，6；95% CI，-67 至 79）。因此，在一项随机临床试验的患者中，我们发现强化 BP 管理与标准 BP 管理相比，ECG 定义的左心房异常的进展或消退没有差异。