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Electrocardiogram in evaluation of resistance to antihypertensive therapy
Insights
Home blood pressure monitoring is crucial for managing hypertension. It more accurately reflects treatment effectiveness and electrocardiographic changes than casual office readings, aiding in better patient care.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
- Electrocardiographic (ECG) changes can indicate LVH.
- Effective blood pressure control is essential for mitigating cardiovascular risks.
Purpose of the Study:
- To investigate the impact of blood pressure control on ECG-evidence of LVH.
- To compare the efficacy of home versus office blood pressure readings in assessing treatment response.
- To determine which blood pressure measurement method best correlates with ECG changes.
Main Methods:
- A longitudinal study of 50 hypertensive patients over nine years.
- Blood pressure monitoring using casual office readings and home self-measurements (twice daily).
- Electrocardiographic analysis focusing on QRS voltage and ST-T segment alterations.
Main Results:
- Electrocardiographic changes correlated better with home blood pressure averages than office readings when discrepancies existed.
- Reduction in maximum precordial QRS voltage significantly correlated with changes in home systolic pressure (r = .460; P < .001).
- Diastolic pressure variations, whether home or office-based, did not show statistically significant correlation with ECG changes.
Conclusions:
- Home blood pressure monitoring is vital for accurately assessing antihypertensive therapy effectiveness.
- Casual office readings may underestimate or misjudge treatment efficacy in some hypertensive patients.
- Consistent home blood pressure monitoring can lead to improved management of hypertension and prevention of LVH progression.
Abstract:
The effect of blood pressure control on the evolution of electrocardiographic evidence of left ventricular hypertrophy was investigated 50 patients with hypertension who were followed up for an average period of nine years. Blood pressure response to treatment was determined both from casual office readings and from weekly averages of twice daily home readings. Changes in the ECG, judged from both alteration in QRS voltage and in ST-T segment, were related to the degree of arterial pressure control. Usually, both home and office arterial pressure responded similarly to antihypertensive therapy, but when there was a difference, electrocardiographic changes correlated best with home prssure averages. Reduction in maximum precordial QRS voltage (Sv1+Rv5-6) correlated best with changes in home systolic pressure (r = .460; P less than .001), but correlation with diastolic pressure variation either at home or in the office did not attain statistical significance (P greater than .10). The present data stress the importance of home pressure measurements in the management of some patients with hypertension and provide evidence that casual office readings may sometimes misjudge the effectiveness of antihypertensive therapy.