Prevalence of left ventricular hypertrophy in Finnish primary health care hypertensive patients

Kumpusalo, Esko; Lappi, Jenni; Miettinen, Heikki; Takala, J

doi:10.1038/sj.jhh.1001166

Cited by 13 publications

(14 citation statements)

References 19 publications

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“…8 Of the many methods of ECG analysis proposed for detection of LVH, sensitivity appears to be improved (possibly up to approximately 50%) by the Cornell product method, which accounts for both QRS voltage and duration, and sensitivity of this method also appears to be less influenced by body habitus than other methods, including the Framingham-adjusted Cornell voltage (which incorporates algorhythms to adjust for age, sex and body mass index in an attempt to improve ECG sensitivity) and SokolowLyon voltage methods. 9,16 Despite the evidence for LVH as an independent cardiovascular risk factor, the study by Kumpusalo et al 17 in the current issue of Journal of Human Hypertension suggests that the majority of hypertensive patients with ECG-LVH may be under-treated, with adequate hypertension control being achieved in only 17% of hypertensives with ECG-LVH managed in general practice. Furthermore, using the sexspecific Cornell product, the prevalence of ECG-LVH amongst these Finnish hypertensives was high, at 14.9% of males and 18.8% of females.…”

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“…The conclusions which can be drawn from the study by Kumpusalo et al 17 are that routine ECG screening for LVH amongst hypertensives has the potential to identify a relatively large proportion of individuals with this additional risk factor for cardiovascular morbidity and mortality, who may then require particularly aggressive antihypertensive therapy to achieve target blood pressure. Epidemiological studies suggest that the prevalence of LVH is currently declining in proportion to the increasing use of antihypertensives and resulting fall in mean systolic and diastolic blood pressure.…”

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The ECG and left ventricular hypertrophy in primary care hypertensives

Conway

Lip

2001

J Hum Hypertens

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Keywords: ECG; left ventricular hypertrophy; primary care hypertensivesWhilst cardiac hypertrophy is initially a compensatory response to the high blood pressure, the increased muscle mass outstrips its oxygen supply and coupled with the reduced coronary vascular reserve seen in hypertension, results in myocardial ischaemia even with normal coronary arteries. Thus beyond a certain point, left ventricular hypertrophy (LVH) secondary to hypertension becomes a major risk factor for myocardial infarction, stroke, sudden death, and congestive cardiac failure, 1 and this increased risk is in addition to that imposed by hypertension itself. Furthermore, hypertensives with LVH are at increased risk of cardiac arrhythmias (atrial fibrillation, ventricular arrhythmias) and atherosclerotic vascular disease (coronary and peripheral artery disease). 1 Patients with hypertension and LVH should therefore be identified for aggressive management, not only of blood pressure, but of all their cardiovascular risk factors.Epidemiological data regarding prevalence of LVH and the increased risk of cardiovascular mortality and morbidity was initially provided by the Framingham Heart Study more than 30 years ago, which employed ECG criteria to define LVH. 2 Conversely, the association between hypertension and LVH is also well-established, 3 leading to a particularly high cardiovascular risk for the uncontrolled hypertensive via the development of LVH. However, the correlation between blood pressures measured in the clinical environment and left ventricular mass is poor. 4 By contrast, 24-h ambulatory blood pressure monitoring (ABPM) provides a closer correlation between average daytime arterial blood pressure and left ventricular mass. 5 Many different criteria for identifying LVH exist, based on both echocardiographic (echo-LVH) and electrocardiographic (ECG-LVH) features, but there is considerable variation in sensitivity and specificity between these methods. 1,6,7 A commonly used screening test for LVH in hypertensives uses the 12-lead ECG and the Sokolow and Lyon criteria, that is, the sum of the S wave in lead V1 and the R wave in leads V5 or V6 on the ECG Ͼ35 mm, with a sensitivity of 22% and specificity of 79%. Other methods have also been evaluated: 6-9 (i) The Romhilt-Estes Point-Score System of у4 has a sensitivity of 12% and specificity of 87%; (ii) The Cornell system has a sensitivity of 31% and specificity of 87%; (iii) the Sokolow-Lyon Index (RaVL у1.1 mV) has a sensitivity of 18% and specificity of 92%; and (iv) the Rodrigez Padial system has a sensitivity of 82% and specificity of 8% respectively. These figures suggest that most forms of interpreting the ECG with regards to LVH are not useful as a screening tool. This can be marginally improved by multiplying QRS-voltage by QRS-duration, thus increasing the specificity to 96% and sensitivity to about 50%. 6,7 Crudely speaking, the features of LVH on ECG normally mean that true LVH is present, but its absence does not mean that LVH is absent. Nevertheless, the specificit...

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The ECG and left ventricular hypertrophy in primary care hypertensives

Conway

Lip

2001

J Hum Hypertens

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“…The prevalence of electrocardiographic LVH in primary health care is low, ranging from 9% to 14% in women and from 15 to 19% in men. 10 Therefore, caution is advisable in extrapolating the results observed in this highly selected, high-risk population to hypertensive patients who are encountered in everyday clinical practice. Further studies will better clarify whether the LIFE Study results can be extrapolated to hypertensive patients with a lower risk profile.…”

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Gender Differences in the Regression of Electrocardiographic Left Ventricular Hypertrophy During Antihypertensive Therapy

Agabiti‐Rosei

Salvetti

2008

Hypertension

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D espite a common underestimation of cardiovascular (CV) risk in women, CV disease represents the leading cause of death in Western countries in both sexes. It is now widely recognized that the pathophysiology and the clinical manifestations of CV diseases differ significantly between genders. After a period of relative "protection" from CV events in the premenopausal phase, the increase in CV risk associated with aging becomes steeper in females after menopause. The mechanisms underlying this phenomenon are not completely understood; changes in body composition, plasma glucose and lipid levels, and in blood pressure (BP) values may partially explain the observed increase in CV risk. A significant effect exerted by gender in cardiac adaptation to increased workload has been described, 1 with women having a greater increase in the prevalence of left ventricular hypertrophy and of concentric geometry with progressive aging.ECG, despite being introduced in clinical practice Ͼ100 years ago, still represents one of the most extensively used diagnostic tools in CV medicine and is a powerful index for the assessment of CV risk in hypertensive patients. Several studies have demonstrated the prognostic significance of left ventricular hypertrophy (LVH) detected by the ECG in hypertensive patients 2 ; in addition, strong evidence exists that favorable changes over time of ECG indices of LVH are associated with a better prognosis in different populations. 3 In this issue of Hypertension, Okin et al 4 report the results of a posthoc analysis performed in 9193 hypertensive patients included in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) Study; during 4.8 years of antihypertensive treatment, women had significantly less reduction in both Cornell product and Sokolow-Lyon voltage than men. Gender differences in the reduction of LVH by both Cornell product and Sokolow-Lyon voltage were already apparent after 6 months and became progressively greater over the course of follow-up.At the end of the study women were 32% less likely to have had greater than the median level of regression of Cornell product LVH and 15% less likely to have had regression of LVH by Sokolow-Lyon criteria. Furthermore, when LVH regression was defined as a reduction of Cornell product or Sokolow-Lyon voltage to below their partition values, significant gender differences were still observed.The study by Okin et al 4 for the first time clearly demonstrates lesser regression of ECG LVH in hypertensive females in comparison with males for similar BP decrease. Of note, the difference was highly significant, even taking into account possible confounders such as baseline ECG LVH levels, baseline and change in BP, treatment group, obesity, age, and other baseline gender differences. The findings of the study give further insights on the evolution of cardiac organ damage in women and are concordant with recent data from the population included in the LIFE echocardiographic substudy. In fact, in 863 patients, Gerdts et al 5 observed a si...

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“…Since most patients referred with hypertension between 1971 and 1986 presented with elevated DBP, this study clearly was biased towards diastolic hypertension. Also, the prevalence of ECG LVH by Sokolow-Lyon criteria was high compared with more recent studies, 28,29 which may indicate an increase in the hypertension awareness and improved control during the last decades. Long-term mortality data were obtained from death certificates.…”

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Left ventricular hypertrophy by Sokolow-Lyon voltage criterion predicts mortality in overweight hypertensive subjects

et al. 2008

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In view of the low sensitivity of Sokolow-Lyon voltage criteria in the assessment of electrocardiographic left ventricular hypertrophy (ECG LVH) in overweight subjects, we determined its clinical utility in 1840 lean and 3555 overweight subjects with hypertension. They were followed prospectively over an average of 11 years by the Department of Health and Social Security Hypertension Care Computer Project. LVH was determined at baseline using the Sokolow-Lyon criterion that is, the amplitude voltage SV1 þ (max RV5 or RV6) X3.5 mV. Overweight status was defined as body mass index (BMI) X25 kg m À2 . Prevalence of ECG LVH was 16% in lean and 12% in overweight women, 35 and 20% in lean and overweight men. For each 0.1 mV increase in ECG voltage as a continuous variable, the age and sex adjusted risk of stroke, coronary heart disease and cardiovascular disease (CVD) mortality increased significantly by 3.0, 1.5 and 1.8% in overweight subjects and by 2.8, 1.8 and 2.4% in lean subjects. After additional adjustments for smoking, blood glucose and serum cholesterol concentration in a subgroup of 654 lean and 1281 overweight subjects with complete information on these variables, an increasing voltage still significantly predicted stroke and CVD mortality in overweight subjects. The excess high risk of dying was evident especially in women with LVH in the highest BMI quartiles. When ECG detects LVH in overweight subjects, it is a good predictor of mortality despite the lower sensitivity in this group.

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Prevalence of left ventricular hypertrophy in Finnish primary health care hypertensive patients

Cited by 13 publications

References 19 publications

The ECG and left ventricular hypertrophy in primary care hypertensives

The ECG and left ventricular hypertrophy in primary care hypertensives

Gender Differences in the Regression of Electrocardiographic Left Ventricular Hypertrophy During Antihypertensive Therapy

Left ventricular hypertrophy by Sokolow-Lyon voltage criterion predicts mortality in overweight hypertensive subjects

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