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Left ventricular hypertrophy, arrhythmias and sudden death in systemic hypertension
1Department of Community Health, University of California, School of Medicine, Davis 95616.
Insights
Left ventricular hypertrophy significantly increases coronary heart disease mortality, especially sudden death. Treating hypertension early, before LV hypertrophy develops, is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Hypertension Research
Background:
- Left ventricular (LV) hypertrophy is a major risk factor for coronary heart disease mortality, including sudden death.
- Despite declining coronary heart disease mortality, sudden death remains a high proportion (50-60%) of deaths.
Purpose of the Study:
- To highlight the underestimation of LV hypertrophy prevalence by electrocardiogram in hypertensive patients.
- To emphasize the prognostic significance of LV hypertrophy in hypertension and the benefits of early treatment.
Main Methods:
- Comparison of LV hypertrophy prevalence using electrocardiogram (ECG) versus echocardiography in hypertensive patients.
- Analysis of the impact of hypertension treatment on LV hypertrophy incidence and regression.
Main Results:
- ECG underestimates LV hypertrophy prevalence in hypertensive patients (5% vs. 44-48% by echocardiography), with ECG sensitivity below 60%.
- Successful hypertension treatment reduces LV hypertrophy incidence and promotes regression.
- Hypertensive patients with LV hypertrophy have a poor prognosis even with treatment.
Conclusions:
- ECG is an insensitive tool for detecting LV hypertrophy in hypertensive individuals.
- Early hypertension management is recommended to prevent or regress LV hypertrophy and improve prognosis.
Abstract:
Left ventricular (LV) hypertrophy is a significant independent risk factor for mortality from coronary heart disease, including sudden death. The proportion of sudden death to total death due to coronary heart disease remains high, at about 50% to 60%, despite the continuing downward trend in coronary heart disease mortality observed in the U.S. during the last decade. Prevalence of LV hypertrophy, determined by electrocardiogram in hypertensive patients (diastolic blood pressure greater than or equal to 90 mm Hg), including tall R wave and evidence of repolarization abnormality, is around 5%. The prevalence of LV hypertrophy by echocardiography is estimated at 44% to 48%. LV hypertrophy on electrocardiogram underestimates the magnitude of the problem of LV hypertrophy in hypertensive patients. Its overall sensitivity is less than 60%. The incidence of LV hypertrophy in hypertensive patients is lower when hypertension is treated successfully than when the patient is left either untreated or inadequately treated; successful treatment of hypertension causes regression of LV hypertrophy. However, hypertensive patients with LV hypertrophy have a poor prognosis despite treatment. The available evidence derived from the results of large clinical trials suggests that hypertensive patients should be treated before there is electrocardiographic evidence of LV hypertrophy.