title: Association of electrocardiographic left ventricular hypertrophy with incident cardiovascular disease in Japanese older hypertensive patients.
abstract: BACKGROUND
  Our aim was to assess whether electrocardiographic left ventricular hypertrophy (ECG-LVH) is associated with a higher risk of cardiovascular disease (CVD) events, independent of 24-hour blood pressure (BP) and circulating levels of norepinephrine and hemostatic factors.
  
  
  METHODS
  In 514 older hypertensive patients (mean age 72.3 years; 37% men), we assessed ambulatory BP values, circulating levels of norepinephrine and hemostatic factors (plasma fibrinogen, prothrombin fragment 1+2 (F1+2), von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1)), and the presence or absence of ECG-LVH (Sokolow-Lyon voltage ≥ 3.5 mV). The incidence of CVD events (i.e., myocardial infarction and stroke) was prospectively ascertained.
  
  
  RESULTS
  During an average 41 months of follow-up (1,751 person-years), 43 stroke and 3 myocardial infarction events occurred. At baseline, patients with ECG-LVH had higher mean 24-hour BP (148.8/83.8mm Hg vs. 135.7/77.2mm Hg) and circulating norepinephrine levels (404.6 pg/ml vs. 336.3 pg/ml) compared to those without ECG-LVH; the differences remained unchanged after adjustment for age, gender, smoking status, presence of diabetes, and antihypertensive medication uses at follow-up time (all P < 0.01). Cox proportional hazards models suggested that the hazard ratio (HR; 95% confidence interval (CI)) of CVD events for those with ECG-LVH was 4.4 (2.3-8.2), and the association between ECG-LVH and incident CVD events remained significant after adjustment for high 24-hour BP (≥130/80mm Hg), nocturnal SBP, circulating norepinephrine and fibrinogen levels (HRs, 3.5-4.2, all P < 0.001).
  
  
  CONCLUSIONS
  In older hypertensive patients, ECG-LVH was associated with a higher risk of CVD events, independent of ambulatory BP parameters and circulating norepinephrine and fibrinogen levels.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Eijiro Sugiyama
authors.initials: ES
authors.lastname: Edison
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. kkario@jichi.ac.jp.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology* / Q000503:physiopathology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D005340:Fibrinogen; D009638:Norepinephrine
keywords: ambulatory blood pressure; blood pressure; cardiovascular disease; hemostatic factors; hypertension; left ventricular hypertrophy; neurohumoral.