Prognostic impact of baseline and serial changes in electrocardiographic left ventricular hypertrophy in resistant hypertension

Gil Fernando Salles, Claudia Regina Lopes Cardoso, Roberto Fiszman, Elizabeth Silaid Muxfeldt
American Heart Journal 2010, 159 (5): 833-40

BACKGROUND: The prognostic value of electrocardiographic left ventricular hypertrophy (ECG-LVH) in resistant hypertension (RH) is unknown. The aim was to evaluate the importance of baseline and serial changes in ECG-LVH as predictors of cardiovascular morbidity and mortality in patients with RH.

METHODS: At baseline and during follow-up, 552 resistant hypertensive patients had 3 ECG-LVH criteria obtained: Sokolow-Lyon, Cornell voltage, and Cornell voltage-duration product. Primary end points were a composite of fatal and nonfatal cardiovascular events and all-cause and cardiovascular mortalities. Total strokes and coronary heart disease (CHD) events were secondary end points. Multiple Cox regression assessed the associations between time-varying ECG-LVH and subsequent end points.

RESULTS: After a median follow-up of 4.8 years, 70 patients died, 46 from cardiovascular causes; and 109 total cardiovascular events occurred, 46 strokes, and 44 CHD events. After adjustment for several cardiovascular risk factors, baseline Cornell voltage and product, but not Sokolow-Lyon voltage, were independent predictors of the composite end point and of all-cause and cardiovascular mortalities. Reductions of all ECG-LVH criteria were protective factors for the composite end point: a 1-SD (1.1 mV) reduction in Sokolow-Lyon voltage was associated with a 35% lower risk (95% CI 10%-53%) of cardiovascular events, whereas prevention or regression of Cornell product LVH criterion implied a 40% lower risk (95% CI 11%-60%). Baseline and serial changes in Sokolow-Lyon voltage were independent predictors of strokes, whereas Cornell voltage was predictive of CHD events.

CONCLUSIONS: Baseline and serial changes in ECG-LVH predict cardiovascular morbidity and mortality in RH patients. Antihypertensive treatment targeted at regression or prevention of ECG-LVH may improve prognosis.

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