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(Hypertension. 2004;44:459.)
© 2004 American Heart Association, Inc.

Scientific Contributions

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

Robert H. Fagard; Jan A. Staessen; Lutgarde Thijs; Hilde Celis; Willem H. Birkenhäger; Christopher J. Bulpitt; Peter W. de Leeuw; Gastone Leonetti; Cinzia Sarti; Jaakko Tuomilehto; John Webster; Yair Yodfat for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators

From the Hypertension and Cardiovascular Rehabilitation Unit (R.H.F., J.A.S., L.T., H.C.), University of Leuven, Leuven, Belgium; Erasmus University (W.H.B.), Rotterdam, the Netherlands; Imperial College, Hammersmith Hospital (C.J.B.), London, UK; University of Maastricht (P.W.d.L.), Maastricht, the Netherlands; Istituto Auxologico Italiano (G.L.), Ospedale San Luca, Milano, Italy; National Public Health Institute and the University of Helsinki (C.S., J.T.), Helsinki, Finland; Clinical Pharmacology Unit (J.W.), Aberdeen Royal Infirmary, Aberdeen, UK; Department of Family Medicine (Y.Y.), Hadassah Medical School, Hebrew University of Jerusalem, Jerusalem, Israel.

Correspondence to R. Fagard, MD, PhD, Professor of Medicine, Hypertension and Cardiovascular Rehabilitation Unit, U.Z.Gasthuisberg-Hypertensie, Herestraat 49, B-3000 Leuven, Belgium. E-mail robert.fagard{at}uz.kuleuven.ac.be

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 (P0.01 for all). A 1-mV decrease in electrocardiographic voltages during follow-up independently predicted a lower incidence of cardiac events (relative hazard rate: 0.86; P0.05), but not of stroke or mortality. In conclusion, electrocardiographic voltages at baseline and their serial changes during follow-up predict subsequent events in older patients with systolic hypertension.

Key Words: antihypertensive therapy • elderly • electrocardiography • hypertension, essential • hypertrophy, cardiac • prognosis

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