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Randomized Controlled Trial
. 2009 Jun;22(6):669-73.
doi: 10.1038/ajh.2009.45. Epub 2009 Mar 5.

Dietary sodium alters the prevalence of electrocardiogram determined left ventricular hypertrophy in hypertension

Anand Vaidya  1 , Rhonda Bentley-Lewis, Xavier Jeunemaitre, Gail K Adler, Jonathan S Williams
Affiliations
Randomized Controlled Trial

Dietary sodium alters the prevalence of electrocardiogram determined left ventricular hypertrophy in hypertension

Anand Vaidya et al. Am J Hypertens. 2009 Jun.

Abstract

Background: Determination of left ventricular hypertrophy (LVH) via electrocardiogram (ECG) is a known independent risk factor for cardiovascular morbidity and mortality in hypertension (HTN). Dietary sodium and HTN are both associated with unfavorable alterations in left ventricular mass, however, to what extent their interplay affects ECG screening for LVH is unclear.

Methods: The effects of controlled dietary sodium manipulation on ECG determinants of LVH in hypertensive subjects were evaluated using well-established voltage criteria for LVH. ECGs from 80 hypertensive subjects were evaluated following random sequence assignment to 7 days of high sodium (HS) intake (200 mEq/24 h), and then 7 days of low sodium (LS) intake (10 mEq/24 h).

Results: Sodium restriction over 7 days resulted in significant decreases in overall, and LVH-specific, ECG voltages. Most subjects exhibited decrements in overall ECG voltage with sodium restriction (72%); however, a smaller subset displayed higher voltages when on LS intake (28%). The prevalence of ECG-determined LVH was significantly lowered with LS diet (HS diet 22/80 (28%) vs. LS diet 8/80 (10%), P < 0.05). Subjects exhibiting reversal of LVH status with sodium restriction were younger, demonstrated salt sensitivity of blood pressure, and lower LVH-specific ECG voltage.

Conclusions: Short-term dietary sodium fluctuations can significantly alter overall ECG voltage and the prevalence of ECG-determined LVH in hypertensive individuals. Inclusion of dietary sodium assessment when screening hypertensive subjects for LVH by ECG may improve the consistency of cardiac risk assessment.

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Conflict of interest statement

Disclosure: There are no conflicts of interest

Figures

Figure 1
Figure 1. Sodium Dependent Voltage Changes
Box plots comparing total ECG voltage (sum of all R + S waves) between HS and LS diets. Boxes depict voltages within the 25th–75th percentiles, whiskers denote the largest non-outlier voltages within 1.5 fold the interquartile range, and the line depicts median voltage.
Figure 2
Figure 2. LVH-Specific Voltage Changes
Box plots depicting specific ECG voltage criteria for LVH between HS and LS diets. A) aVL voltage, B) Sokolow-Lyon voltage, C) Cornell voltage for males, D) Cornell voltage for females.
See this image and copyright information in PMC

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