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Published on: September 25, 2017
Interrelations Between Hypertension and Electrocardiographic Left Ventricular Hypertrophy and Their Associations With
Xiangkun Cao1, Stephen T Broughton1, George S Waits1
1Department of Internal Medicine, General Medicine Section, Wake Forest School of Medicine, Winston Salem, North Carolina.
Insights
Hypertension significantly increases the risk of electrocardiogram-left ventricular hypertrophy (ECG-LVH). While both ECG-LVH and hypertension predict cardiovascular disease mortality, hypertension
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Electrocardiogram (ECG) is a primary tool for assessing left ventricular hypertrophy (LVH) in clinical trials.
- Existing understanding of hypertension's link to LVH often relies on imaging studies, creating a knowledge gap.
- This study investigates the relationship between hypertension, ECG-derived LVH, and cardiovascular disease (CVD) mortality.
Purpose of the Study:
- To examine the interrelationships between hypertension, ECG-LVH, and CVD mortality.
- To validate the use of ECG for LVH assessment in hypertension research.
- To elucidate the role of ECG-LVH in mediating the association between hypertension and CVD mortality.
Main Methods:
- Analysis of data from 6,105 patients without prior CVD, followed for a median of 14.0 years.
- Assessment of ECG-LVH prevalence across different systolic blood pressure categories.
- Statistical modeling (Cox regression) to evaluate associations between hypertension, ECG-LVH, and CVD mortality.
Main Results:
- ECG-LVH prevalence increased exponentially with rising systolic blood pressure (p<0.001).
- Hypertension was associated with over double the odds of ECG-LVH (OR 2.45), and increased SBP further elevated these odds (OR 1.49 per SD).
- Both ECG-LVH and hypertension independently predicted CVD mortality, but hypertension's association remained significant after adjusting for ECG-LVH, while ECG-LVH's attenuated.
Conclusions:
- The relationship between hypertension and ECG-LVH mirrors findings from imaging studies, supporting ECG's utility in hypertension trials.
- ECG-LVH does not fully explain the link between hypertension and CVD mortality, indicating other pathways are involved.
- Hypertension's impact on CVD mortality is multifactorial, with LVH being only one contributing element.
Abstract:
Electrocardiogram (ECG) is the most common method for assessment of left ventricular hypertrophy (LVH) in contemporary clinical trials. However, our understanding of the relation between hypertension and LVH is based on studies used imaging to ascertain LVH. To fill this gap in knowledge, we examined the interrelationships between hypertension, ECG-LVH and cardiovascular disease (CVD) mortality in 6,105 patients free of CVD who were followed for 14.0 years (median). The was an exponentianl ECG-LVH prevalence rates (2.40%, 4.45%, 5.75%, 8.51%, 14.38%) were exponentially increases as systolic blood pressure increases (<120 mm Hg, 120 to 129 mm Hg, 130 to 139 mm Hg, 140 to 159 mm Hg, >160 mm Hg, respectively); trend p value <0.001. Hypertension was associated with more than double the risk of ECG-LVH (odds ratio (95% confidence interval [CI]) 2.45 [1.83, 3.30]), and each standard-deviation increase in systolic blood pressure (19 mm Hg) was associated with 49% increased odds of ECG-LVH (odds ratio [95% CI] 1.49 [1.38, 1.61]). During follow-up, 733 CVD-deaths occurred. In separate Cox models, both ECG-LVH and hypertension were associated with CVD mortality (hazard ratio [95% CI] 1.39 [1.07, 1.81] and 1.39 [1.18, 1.62], respectively). However, when ECG-LVH and hypertension were entered together in the same model, the risk of CVD mortality was essentially unchanged for hypertension after adjusting for ECG-LVH, but markedly attenuated for ECG-LVH after adjusting for hypertension. In conclusion, the relation between hypertension and ECG-LVH follows a similar pattern to that reported in literature for imaging-LVH which provides support for the current practice of using ECG for assessment of LVH in contemporary hypertension clinical trials. The inability of ECG-LVH to explain the association between hypertension and CVD mortality suggests that LVH is only one of many factors by which hypertension exerts its impact on CVD.
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