Electrocardiographic Left Ventricular Hypertrophy Predicts Cardiovascular Morbidity and Mortality in Hypertensive Patients: The ALLHAT Study

• Published in: American journal of hypertension 2017-09, Vol.30 (9), p.914-922
• Main Authors: Bang, Casper N, Soliman, Elsayed Z, Simpson, Lara M, Davis, Barry R, Devereux, Richard B, Okin, Peter M
• Format: Article
• Language: English
• Subjects: Aged; Amlodipine - therapeutic use; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Cause of Death; Chlorthalidone - therapeutic use; Disease Progression; Editor's Choice; Electrocardiography; Female; Humans; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - mortality; Hypertension - physiopathology; Hypertrophy, Left Ventricular - diagnosis; Hypertrophy, Left Ventricular - mortality; Hypertrophy, Left Ventricular - physiopathology; Lisinopril - therapeutic use; Male; Middle Aged; Original Contributions; Predictive Value of Tests; Risk Factors; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1093/ajh/hpx067

Abstract BACKGROUND Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular (CV) morbidity and mortality. However, the predictive value of ECG LVH in treated hypertensive patients remains unclear. METHODS A total of 33,357 patients (aged ≥ 55 years) with hypertension and at least 1 other coronary heart disease (CHD) risk factor were randomized to chlorthalidone, amlodipine, or lisinopril. The outcome of the present study was all-cause mortality; and secondary endpoints were CHD, nonfatal myocardial infarction (MI), stroke, angina, heart failure (HF), and peripheral arterial disease. Cornell voltage criteria (S in V3 + R in aVL > 28 [men] or >22 mm [women]) defined ECG LVH. RESULTS ECGs were available at baseline in 26,384 patients. Baseline Cornell voltage LVH was present in 1,741 (7%) patients, who were older (67.4 vs. 66.6 years, P < 0.001), more likely to be female (74 vs. 44%, P < 0001) with a higher systolic blood pressure (151 vs. 146 mm Hg, P < 0.001) than patients without ECG LVH. During 5.0 ± 1.4 years mean follow-up, baseline and in-study ECG LVH was significantly associated with 29 to 98% increased risks of all-cause mortality, MI, CHD, stroke, and HF in multivariable Cox analyses. CONCLUSIONS Baseline Cornell voltage LVH is associated with increased CV morbidity and all-cause mortality in treated hypertensive patients independent of treatment modality and other CV risk factors. CLINICAL TRIALS REGISTRATION Trial Number NCT00000542.