Close relationship between electrocardiogram QRS duration and the risk of developing hypertension

Electrocardiogram QRS duration is associated with cardiovascular events and all-cause death. The present study was conducted to investigate the hypothesis that the QRS duration predicts the future development of hypertension in the Japanese general population with normal blood pressure. Overall, 13,382 individuals without bundle branch block, Wolff-Parkinson-White syndrome, complete atrioventricular block, pacemaker implantation, or old myocardial infarction on electrocardiogram were enrolled. The cross-sectional analysis indicated that the QRS duration was longer in hypertensive than in normotensive participants. After excluding the participants with hypertension, the remaining 9293 participants with normal blood pressure (male = 5425, 50.2 ± 11.7 years) were followed up for the median of 4 years with an endpoint of hypertension development. During the follow-up period, 1953 participants developed hypertension (50.6 per 1000 person-year). Kaplan-Meier analysis revealed that the incidence of hypertension increased across the quartiles of participants based on QRS duration at baseline as 39.0, 48.6, 53.7, and 62.4 per 1000 person-years in the first, second, third, and fourth quartiles, respectively. Univariate analysis confirmed a significant impact of QRS duration on the development of hypertension. In the multivariate Cox hazard regression analysis adjusted for possible confounding variables, QRS duration was an independent predictor of the development of hypertension. These results suggest the close association between electrocardiogram QRS duration and the future development of hypertension in the Japanese general population. Moreover, alterations in the intraventricular conduction may precede clinically apparent hypertension.