The hidden role of left atrial strain: insights into end-organ damage in dipper and nondipper hypertension

Hypertension is a major global health concern associated with significant morbidity and mortality due to its effects on target organs such as the heart, kidneys, and brain. Non-dipper hypertension, characterized by insufficient nocturnal blood pressure reduction leading to sustained hemodynamic load, is linked to higher risks of end-organ damage. This study evaluates the impact of hypertension on LA anatomy and physiomechanics and explores the association of LA strain parameters with hypertensive heart disease and nephropathy. This prospective, single-center cohort study included 135 participants: 35 healthy controls, 50 dipper hypertension, and 50 non-dipper hypertension patients. All participants underwent 24-h ABPM, biochemical analysis, and transthoracic echocardiography, including speckle-tracking echocardiography, a novel technique for LA strain analysis. LA diameter,LASr, and LAVI maximum were identified as significant parameters associated with hypertensive end-organ damage. Non-dipper hypertension was associated with significantly higher 24-h blood pressure values and reduced nocturnal dipping compared to dipper hypertension. LA strain parameters(LASr, LAScd, LASct) were significantly lower in the non-dipper group. These reductions indicate impaired left atrial mechanics and early cardiac dysfunction. Logistic regression revealed that LA diameter, LASr, and LAVI maximum were significant variables associated with hypertensive heart disease, whereas only LASr was significantly associated with hypertensive nephropathy. LA strain analysis provides valuable insights into the pathophysiology of hypertension and its complications. The findings support the use of LA parameters as cost-effective, noninvasive biomarkers for assessing associations with hypertensive heart disease and nephropathy, enabling early risk stratification. This emphasizes the importance of enhanced monitoring and tailored interventions for high-risk patients.