Sequential ECG can identify hypertensive patients at high risk


WESTPORT, CT (Reuters Health) – Electrocardiography has more value in detecting left ventricular hypertrophy (LVH) than has been thought, according to a report in the August issue of the American Journal of Hypertension.

"The problem with the electrocardiogram is its relatively low sensitivity in detecting true LVH, so it misses most people with LVH," Dr. Peter M. Okin noted in an interview with Reuters Health. But two ECGs and an echocardiogram have additive value for detecting patients at high risk for death, stroke and myocardial infarction, he said.

As part of the LIFE Study, Dr. Okin, from Weill Medical College of Cornell University, New York, and colleagues reviewed a baseline ECG and echocardiogram for 906 hypertensive patients who had had a screening ECG a median of 23 days previously.

Even after adjustment for older age, systolic blood pressure, and body mass index, patients with two ECGs indicating LVH had more than a fourfold higher risk of echocardiographic LVH than patients who did not have LVH on either ECG, the researchers note.

"These findings suggest that persistence of LVH on serial ECG may identify patients at especially high risk of subsequent morbid and mortal events," Dr. Okin and his associates infer.

"It is worth emphasizing," they add, "that even patients in whom ECG LVH was not present on the second ECG had a >50% likelihood of having LVH by echocardiogram, further illustrating the clinical value of ECG methods for identifying hypertensive patients at high risk."

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