Prognostic utility of electrocardiograms in patients with hypertension older than 65 years. The PAFRES study

P Guedes Ramallo; P Morillas Blasco; M J Gómez Martínez; L Núñez Martínez; A Romero Valero; F Peris Castelló; F M Rodríguez Santiago; N Vicente Ibarra; M A Quintanilla Tello; E Castilla Cabanes; L Fácila Rubio; V Pallarés-Carratalá

doi:10.1016/j.rce.2019.05.007

Prognostic utility of electrocardiograms in patients with hypertension older than 65 years. The PAFRES study

Rev Clin Esp (Barc). 2020 Mar;220(2):100-108. doi: 10.1016/j.rce.2019.05.007. Epub 2019 Jul 2.

[Article in English, Spanish]

Affiliations

¹ Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España. Electronic address: paulaguedesramallo@gmail.com.
² Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España.
³ Servicio de Cardiología, Hospital General de Valencia, Valencia, España.
⁴ Unidad de Vigilancia de la Salud, Unión de Mutuas. Departamento de Medicina, Universitat Jaume I, Castellón, España.

PMID: 31272678
DOI: 10.1016/j.rce.2019.05.007

Abstract

Objective: Left ventricular hypertrophy is the most common marker of target organ damage in arterial hypertension. Electrocardiograms are typically performed to identify left ventricular hypertrophy. The aim of this study was to analyse the prognostic utility of other electrocardiographic abnormalities in patients with arterial hypertension, beyond ventricular hypertrophy.

Materials and methods: The study included 1003 patients older than 65years with arterial hypertension. We recorded risk factors, previous cardiovascular history and medical treatment and analysed various electrocardiographic abnormalities including the Sokolow-Lyon index, the Cornell index, ventricular overload and branch blocks. The study conducted a 2-year follow-up, recording the major cardiovascular events (mortality, myocardial infarction, stroke and hospitalisation for heart failure).

Results: The study population's mean age was 72.9±5.8years, 47.5% of whom were men. During the follow-up, 13.9% of the patients experienced a major cardiovascular event. These patients were older, more often smokers and engaged in less physical exercise, without presenting differences in the antihypertensive therapy or blood pressure control. The ventricular overload pattern (HR: 1.93; 95%CI: 1.160-3.196; P=.011) and the complete left bundle branch block (HR: 2.27; 95%CI: 1.040-4.956; P=.040) behaved as independent electrocardiographic predictors of major cardiovascular events; however, left ventricular hypertrophy using the Sokolow and/or Cornell index did not behave as such.

Conclusions: For patients with hypertension, the presence in the baseline electrocardiogram of complete left bundle branch block or a pattern of ventricular overload identifies a population at increased cardiovascular risk.

Keywords: Arterial hypertension; Bloqueo de rama izquierda; Electrocardiografía; Electrocardiography; Hipertensión arterial; Hipertrofia del ventrículo izquierdo; Left bundle branch block; Left ventricular hypertrophy; Patrón de sobrecarga ventricular; Prognosis; Pronóstico; Ventricular overload pattern.