Electrocardiography in Hypertensive Patients without Cardiovascular Events: A Valuable Predictor Tool?

Abstract

Background. Hypertension is an important risk factor of cardiovascular (CV) disease. An early diagnosis of target organ damage could prevent major CV events. Electrocardiography (ECG) is a valuable clinical technique, with wide availability and high specificity, used in evaluation of hypertensive patients. However, the use of ECG as a predictor tool is controversial given its low sensitivity. This study aims to characterise ECG features in a hypertensive population and identify ECG abnormalities that could predict CV events. Methods. We studied 175 hypertensive patients without previous CV events during a follow-up mean of 4.0 ± 2.20 years. ECGs and pulse wave velocity were performed in all patients. Clinical characteristics and ECG abnormalities were evaluated and compared between the patients as they presented CV events. Results. Considering the 175 patients (53.14% male), the median age was 62 years. Median systolic blood pressure was 140  mmHg and diastolic blood pressure was 78 mmHg. Median PWV was 9.8 m/s. Of the patients, 39.4% were diabetic, 78.3% had hyperlipidaemia, and 16.0% had smoking habits. ECG identified left ventricular (LV) hypertrophy in 29.71% of the patients, and a LV strain pattern was present in 9.7% of the patients. Twenty-nine patients (16.57%) had a CV event. Comparative analyses showed statistical significance for the presence of a LV strain pattern in patients with CV events ( $p=0.01$ ). Univariate and multivariate analysis confirmed that a LV strain pattern was an independent predictor of CV event (HR 2.66, 95% IC 1.01–7.00). In the survival analysis, the Kaplan–Meier curve showed a worse prognosis for CV events in patients with a LV strain pattern ( $p=0.014$ ). Conclusion. ECG is a useful daily method to identify end-organ damage in hypertensive patients. In our study, we also observed that it may be a valuable tool for the prediction of CV events.