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Vol. 220. Issue 2.
Pages 100-108 (March 2020)
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Vol. 220. Issue 2.
Pages 100-108 (March 2020)
Original article
Prognostic utility of electrocardiograms in patients with hypertension older than 65 years. The PAFRES study
Utilidad pronóstica del electrocardiograma en pacientes hipertensos mayores de 65 años. Estudio FAPRES
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P. Guedes Ramalloa,
Corresponding author
paulaguedesramallo@gmail.com

Corresponding author.
, P. Morillas Blascoa, M.J. Gómez Martíneza, L. Núñez Martíneza, A. Romero Valeroa, F. Peris Castellóa, F.M. Rodríguez Santiagoa, N. Vicente Ibarraa, M.A. Quintanilla Telloa, E. Castilla Cabanesa, L. Fácila Rubiob, V. Pallarés-Carratalác
a Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, Spain
b Servicio de Cardiología, Hospital General de Valencia, Valencia, Spain
c Unidad de Vigilancia de la Salud, Unión de Mutuas. Departamento de Medicina, Universitat Jaume I, Castellón, Spain
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Figures (2)
Tables (4)
Table 1. Baseline characteristics, personal history, laboratory variables and medical treatment according to the presentation of major cardiovascular events during the follow-up.
Table 2. Electrocardiographic characteristics of the population according to the presentation of major cardiovascular events during the follow-up.
Table 3. Independent predictors of major cardiovascular events during the follow-up according to the Cox regression analysis.
Table 4. Predictors of major cardiovascular events during the follow-up according to the multivariate Cox regression analysis in patients older than 80 years.
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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 analyze 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 analyzed 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 hospitalization 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
Prognosis
Left ventricular hypertrophy
Electrocardiography
Left bundle branch block
Ventricular overload pattern
Resumen
Objetivo

La hipertrofia ventricular izquierda es el marcador de daño de órgano diana más frecuente en la hipertensión arterial. Habitualmente se realiza un ECG para su identificación. El objetivo de este trabajo es analizar la utilidad pronóstica de otras alteraciones electrocardiográficas en pacientes hipertensos, más allá de la hipertrofia ventricular.

Materiales y métodos

Se incluyeron 1.003 pacientes hipertensos mayores de65años. Se recogieron factores de riesgo, historia cardiovascular previa y tratamiento médico. Se analizaron diferentes alteraciones electrocardiográficas, incluyendo índice de Sokolow-Lyon, índice de Cornell, presencia de sobrecarga ventricular y bloqueos de rama, entre otros. Se llevó a cabo un seguimiento de 2años con recogida de eventos cardiovasculares mayores (mortalidad, infarto de miocardio, accidentes cerebrovascular o ingreso por insuficiencia cardiaca).

Resultados

La edad media de la población era de 72,9±5,8años, con un 47,5% de varones. Durante el seguimiento el 13,9% sufrieron un evento cardiovascular mayor. Estos pacientes eran de mayor edad, más fumadores y practicaban menos ejercicio físico, sin presentar diferencias en el tratamiento antihipertensivo empleado ni en el control tensional. El patrón de sobrecarga ventricular (HR: 1,93; IC95%: 1,160-3,196; p=0,011) y el bloqueo completo de rama izquierda (HR: 2,27; IC95%: 1,040-4,956; p=0,040) se comportaron como factores electrocardiográficos predictores independientes de eventos cardiovasculares mayores, no así la hipertrofia ventricular izquierda por Sokolow y/o Cornell.

Conclusiones

En pacientes hipertensos, la existencia en el ECG basal de un bloqueo completo de rama izquierda o un patrón de sobrecarga ventricular identifica a una población de mayor riesgo cardiovascular.

Palabras clave:
Hipertensión arterial
Pronóstico
Hipertrofia del ventrículo izquierdo
Electrocardiografía
Bloqueo de rama izquierda
Patrón de sobrecarga ventricular

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