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Randomized Controlled Trial
. 2017 Sep 1;30(9):914-922.
doi: 10.1093/ajh/hpx067.

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

Casper N Bang  1   2 , Elsayed Z Soliman  3 , Lara M Simpson  4 , Barry R Davis  4 , Richard B Devereux  1 , Peter M Okin  1 ; ALLHAT Collaborative Research Group
Affiliations
Randomized Controlled Trial

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

Casper N Bang et al. Am J Hypertens. .

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.

Keywords: Cornell voltage; blood pressure; electrocardiographic left ventricular hypertrophy; hypertension.

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Figures

Figure 1.
Figure 1.
Death rates by baseline electrocardiographic left ventricular hypertrophy. Abbreviation: LVH, left ventricular hypertrophy.
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