Hypertension. 2004 Aug 23 [Epub ahead of print]

Prognostic Significance of Electrocardiographic Voltages and Their Serial Changes in Elderly With Systolic Hypertension.

Fagard RH, Staessen JA, Thijs L, Celis H, Birkenhager WH, Bulpitt CJ, De Leeuw PW, Leonetti G, Sarti C, Tuomilehto J, Webster J, Yodfat Y.

Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, Leuven, Belgium; Erasmus University, Rotterdam, the Netherlands; Imperial College, Hammersmith Hospital, London, UK; University of Maastricht, Maastricht, the Netherlands; Istituto Auxologico Italiano, Ospedale San Luca, Milano, Italy; National Public Health Institute and the University of Helsinki, Helsinki, Finland; Clinical Pharmacology Unit, Aberdeen Royal Infirmary, Aberdeen, UK; Department of Family Medicine, Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel.

The aim of the present study was to assess the prognostic value of ECG voltages at baseline and their serial changes during follow-up in a large prospective study with standardized follow-up and strictly defined end points. Patients who were 60 years old or older, with systolic blood pressure of 160 to 219 mm Hg and diastolic pressure <95 mm Hg, were randomized into the double-blind placebo-controlled Systolic Hypertension in Europe trial. Active treatment consisted of nitrendipine, which could be combined with or replaced by enalapril, hydrochlorothiazide, or both. At the end of the double-blind part of the trial (median follow-up, 2.0 years), follow-up was extended and all patients received active study drugs (median total follow-up, 6.1 years). Electrocardiography was performed at baseline and yearly thereafter. Electrocardiographic left ventricular mass was prospectively defined as the sum of 3 voltages (RaVL+SV1+RV5), which averaged 3.1+/-1.0 mV. The adjusted relative hazard rate, associated with a 1 mV higher sum at baseline, amounted to 1.10 and 1.15 for all-cause and cardiovascular mortality and to 1.21 and 1.18 for strokes and cardiac events, respectively (P</=0.01 in of at with a and hypertension.< 0.86; rate: hazard (relative cardiac incidence lower predicted independently decrease 1-mV A all). for>