Published Online
on March 22, 2004

A more recent version of this article appeared on May 1, 2004

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Submitted on November 6, 2003
Revised on December 1, 2003

QRS Duration and QT Interval Predict Mortality in Hypertensive Patients With Left Ventricular Hypertrophy. The Losartan Intervention for Endpoint Reduction in Hypertension Study

Lasse Oikarinen^*; Markku S. Nieminen; Matti Viitasalo; Lauri Toivonen; Sverker Jern; Björn Dahlöf; Richard B. Devereux; Peter M. Okin; for the LIFE Study Investigators

From the Division of Cardiology (L.O., M.S.N., M.V., L.T.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Sahlgrenska University Hospital/Östra (S.J., B.D.), Göteborg, Sweden; and Division of Cardiology (R.B.D., P.M.O.), Department of Medicine, Weill Medical College of Cornell University, New York, NY.

^* To whom correspondence should be addressed. E-mail: lasse.oikarinen{at}kolumbus.fi.

Abstract--Left ventricular hypertrophy is a risk factor for cardiovascular mortality, including sudden cardiac death. Experimentally, left ventricular hypertrophy delays ventricular conduction and prolongs action potential duration. Electrocardiographic QRS duration and QT interval measures reflect these changes, but whether these measures can further stratify risk in patients with electrocardiographic left ventricular hypertrophy is unknown. We measured the QRS duration and QT intervals from the baseline 12-lead electrocardiograms in the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) study, which included hypertensive patients with electrocardiographic evidence of left ventricular hypertrophy randomized to either losartan-based or atenolol-based treatment to lower blood pressure. In the present study, we related study baseline electrocardiographic measures to cardiovascular and all-cause mortality. There were 5429 patients (male 45.8%; mean age 66±7 years) included in the present analyses. After a mean follow-up of 4.9±0.8 years, there were 417 deaths from all causes, including 214 cardiovascular deaths. In separate univariate Cox regression analyses, QRS duration and several QT measures were significant predictors of cardiovascular mortality and all-cause mortality. However, in multivariate Cox analyses including all electrocardiographic measures and adjusting for other risk factors as well as treatment strategy, only QRS duration and maximum rate-adjusted QT_apex interval remained as significant independent predictors of cardiovascular (P=0.022 and P=0.037, respectively) and all-cause mortality (P=0.038 and P=0.002, respectively). In conclusion, in a hypertensive risk population identified by electrocardiographic left ventricular hypertrophy, increased QRS duration and maximum QT_apex interval can further stratify mortality risk even in the setting of effective blood pressure-lowering treatment.

Key words: electrocardiography • hypertension • mortality • hypertrophy

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