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Prevalence and prognosis of ECG abnormalities in normotensive and hypertensive individuals

Lehtonen, Arttu O.; Puukka, Pauli; Varis, Juha; Porthan, Kimmo; Tikkanen, Jani T.; Nieminen, Markku S.; Huikuri, Heikki V.; Anttila, Ismo; Nikus, Kjell; Kähönen, Mika; Jula, Antti; Niiranen, Teemu J.

doi: 10.1097/HJH.0000000000000882
ORIGINAL PAPERS: Heart
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Objective: To define the prevalence and prognosis of ECG abnormalities in hypertensive individuals.

Methods: ECG, blood pressure and other cardiovascular risk factors were recorded in a nationwide population sample of 5800 Finns. The presence of 15 ECG abnormalities was evaluated. Participants were divided into categories by blood pressure and followed for coronary heart (CHD) and cardiovascular disease (CVD) events.

Results: Mean follow-up was 10.4 ± 2.2 years. The age- and sex-adjusted prevalence rates of ECG abnormalities were generally higher in the hypertensive participants than in normotensive individuals. In multivariable-adjusted Cox models, the following ECG abnormalities predicted CHD in hypertensive participants: left ventricular hypertrophy (LVH) by Sokolow-Lyon criteria [hazard ratio, 1.47; 95% confidence interval (CI), 1.07–2.01; P = 0.02], LVH with ST-depression and negative T wave (ST/T changes) (hazard ratio, 2.31; 95% CI, 1.20–4.43, P = 0.01), ST/T changes (hazard ratio, 2.12; 95% CI, 1.34–3.36; P = 0.001), positive T wave in lead aVR (AVRT+) (hazard ratio, 1.74; 95% CI, 1.15–2.64; P = 0.009) and poor R-wave progression (hazard ratio, 2.02; 95% CI, 1.27–3.22; P = 0.003). These ECG abnormalities were also significant predictors of CVD in hypertensive participants (P ≤ 0.03 for all). Nonspecific intraventricular conduction delay predicted CVD in the whole population (hazard ratio, 1.50; 95% CI, 1.06–2.13; P = 0.02). Prolonged QT interval, abnormal P-wave indices, left axis deviation and early repolarization pattern were not associated with CHD or CVD.

Conclusion: ECG abnormalities are highly prevalent in hypertensive individuals. LVH is still the cornerstone of cardiovascular risk assessment in hypertensive patients. The additional assessment of ST/T changes, AVRT+ and poor R-wave progression in ECGs could improve risk prediction in hypertensive patients.

aDepartment of Health, National Institute for Health and Welfare Turku

bDivision of Medicine, Turku University Central Hospital, Turku

cDivision of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki

dMedical Research Center, Oulu University Central Hospital and University of Oulu, Oulu

eDivision of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki

fHeart Center, Tampere University Hospital and School of Medicine, Tampere University

gDepartment of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland

hFramingham Heart Study, Framingham, Massachusetts, USA

Correspondence to Arttu O. Lehtonen, MD, Department of Health, National Institute for Health and Welfare, P.O. Box 57, 20521, Turku, Finland. Tel: +358 40 0249183; e-mail: arolle@utu.fi

Abbreviations: AUC, area under receiver-operating characteristic curve; AVRT+, positive T wave in lead aVR; CI, confidence interval; IDI, integrated discrimination index; IVCD, nonspecific intraventricular conduction delay; LVH, left ventricular hypertrophy; PTF, P terminal force; ST/T changes, ST-depression with negative T wave

Received 18 November, 2015

Revised 12 January, 2016

Accepted 18 January, 2016

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