Evaluation of the electrocardiogram in hypertensive patients: the LOMIR-MCT-IL study experience

Electrocardiograms (ECGs) of hypertensive men enrolled into the LOMIR-MCT-IL study were evaluated at entry and after 1 year of follow-up. The sensitivity of a modified version of the Minnesota Code (MC) to detect ECG abnormalities was compared with the diagnosis of the treating physician. Changes in the ECG were related to blood pressure and heart rate. A total of 368 patients with mild-to-moderate hypertension were included in a double-blind multicentre study to evaluate the quality of life with different treatments (isradipine, methyldopa or placebo). ECGs of 335 patients at entry and 232 patients who completed the study were available for evaluation by the treating physician, and a central cardiology unit using the modified MC. The most frequent abnormality recognized by the MC was an abnormal P wave (n = 77, 23%). Abnormal repolarization (10%), increased voltage of the QRS (5.4%) and abnormal intraventricular conduction (10%) were the other most frequent abnormalities. No correlation was detected between the abnormal P wave and other ECG abnormalities. Patients with an abnormal P wave showed significantly higher systolic blood pressure (SBP) (p < 0.001) and heart rate (p < 0.05). At the end of follow-up, abnormal P waves were still present in 58 (25%) of the patients. In 21 patients, the abnormal P wave did not change from entry and, in 37, the abnormality developed in spite of a normalized blood pressure. In 56 patients, the abnormal P wave was no longer present. Correlation between diagnosis by the MC and the physician was poor.(ABSTRACT TRUNCATED AT 250 WORDS)