title: Prevalence and prognosis of ECG abnormalities in normotensive and hypertensive individuals.
abstract: OBJECTIVE
  To define the prevalence and prognosis of ECG abnormalities in hypertensive individuals.
  
  
  METHODS
  ECG, blood pressure and other cardiovascular risk factors were recorded in a nationwide population sample of 5800 Finns. The presence of 15 ECG abnormalities was evaluated. Participants were divided into categories by blood pressure and followed for coronary heart (CHD) and cardiovascular disease (CVD) events.
  
  
  RESULTS
  Mean follow-up was 10.4 ± 2.2 years. The age- and sex-adjusted prevalence rates of ECG abnormalities were generally higher in the hypertensive participants than in normotensive individuals. In multivariable-adjusted Cox models, the following ECG abnormalities predicted CHD in hypertensive participants: left ventricular hypertrophy (LVH) by Sokolow-Lyon criteria [hazard ratio, 1.47; 95% confidence interval (CI), 1.07-2.01; P = 0.02], LVH with ST-depression and negative T wave (ST/T changes) (hazard ratio, 2.31; 95% CI, 1.20-4.43, P = 0.01), ST/T changes (hazard ratio, 2.12; 95% CI, 1.34-3.36; P = 0.001), positive T wave in lead aVR (AVRT+) (hazard ratio, 1.74; 95% CI, 1.15-2.64; P = 0.009) and poor R-wave progression (hazard ratio, 2.02; 95% CI, 1.27-3.22; P = 0.003). These ECG abnormalities were also significant predictors of CVD in hypertensive participants (P ≤ 0.03 for all). Nonspecific intraventricular conduction delay predicted CVD in the whole population (hazard ratio, 1.50; 95% CI, 1.06-2.13; P = 0.02). Prolonged QT interval, abnormal P-wave indices, left axis deviation and early repolarization pattern were not associated with CHD or CVD.
  
  
  CONCLUSIONS
  ECG abnormalities are highly prevalent in hypertensive individuals. LVH is still the cornerstone of cardiovascular risk assessment in hypertensive patients. The additional assessment of ST/T changes, AVRT+ and poor R-wave progression in ECGs could improve risk prediction in hypertensive patients.
authors.affiliation: aDepartment of Health, National Institute for Health and Welfare Turku bDivision of Medicine, Turku University Central Hospital, Turku cDivision of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki dMedical Research Center, Oulu University Central Hospital and University of Oulu, Oulu eDivision of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki fHeart Center, Tampere University Hospital and School of Medicine, Tampere University gDepartment of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland hFramingham Heart Study, Framingham, Massachusetts, USA.
authors.forename: Arttu O
authors.initials: AO
authors.lastname: Lehtonen
authors.forename: Pauli
authors.initials: P
authors.lastname: Puukka
authors.forename: Juha
authors.initials: J
authors.lastname: Varis
authors.forename: Kimmo
authors.initials: K
authors.lastname: Porthan
authors.forename: Jani T
authors.initials: JT
authors.lastname: Tikkanen
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
authors.forename: Ismo
authors.initials: I
authors.lastname: Anttila
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus
authors.forename: Mika
authors.initials: M
authors.lastname: Kähönen
authors.forename: Antti
authors.initials: A
authors.lastname: Jula
authors.forename: Teemu J
authors.initials: TJ
authors.lastname: Niiranen
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D001794:Blood Pressure; D004562:Electrocardiography; D005260:Female; D005387:Finland / Q000453:epidemiology; D040361:Healthy People Programs / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors