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Changes in electrocardiographic left ventricular hypertrophy and risk of major cardiovascular events in isolated systolic hypertension: The LIFE study

Journal of Human Hypertension volume 25, pages 178–185 (2011)Cite this article

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Abstract

The predictive value of changes in the severity of electrocardiographic left ventricular hypertrophy (ECG-LVH) during antihypertensive therapy remains unclear in isolated systolic hypertension (ISH). In a Losartan Intervention For Endpoint reduction in hypertension substudy, we included 1320 patients aged 54–83 years with systolic blood pressure (BP) of 160–200 mm Hg, diastolic BP <90 mm Hg and ECG-LVH by Cornell voltage-duration product and/or Sokolow–Lyon voltage criteria, randomized to losartan- or atenolol-based treatment with a mean follow-up of 4.8 years. The composite end point of cardiovascular death, non-fatal myocardial infarction (MI) or stroke occurred in 179 (13.6%) patients. In Cox regression models controlling for treatment, Framingham risk score, as well as baseline and in-treatment BP, less severe in-treatment ECG-LVH by Cornell product and Sokolow–Lyon voltage was associated with 17 and 25% risk reduction for the composite end point (adjusted hazard ratio (HR) 0.83, 95% confidence interval (95% CI:) 0.75–0.92, P=0.001 per 1050 mm × ms (1 s.d.) lower Cornell product; and HR 0.75, 95% CI: 0.65–0.87, P<0.001 per 10.5 mm (1 s.d.) lower Sokolow–Lyon voltage). In parallel analyses, lower Cornell product and Sokolow–Lyon voltage were associated with lower risks of cardiovascular mortality and MI, and lower Sokolow–Lyon voltage with lower risk of stroke. Lower Cornell product and Sokolow–Lyon voltage during antihypertensive therapy are associated with lower likelihoods of cardiovascular events in patients with ISH.

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Authors and Affiliations

  1. Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway

    A C K Larstorp & S E Kjeldsen

  2. Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA

    P M Okin & R B Devereux

  3. Department of Internal Medicine, The Cardiovascular Research Unit, Cardiology Section, Glostrup University Hospital, Glostrup, Denmark

    M H Olsen

  4. Division of Cardiology, Holbaek Hospital, Holbaek, Denmark

    H Ibsen

  5. Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden

    B Dahlöf

  6. Rigshospitalet, The Heart Center, Copenhagen, Denmark

    K Wachtell

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  1. A C K Larstorp
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  2. P M Okin
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  3. R B Devereux
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  4. M H Olsen
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Correspondence to A C K Larstorp.

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Competing interests

The LIFE study (Losartan Intervention For Endpoint reduction in hypertension) was originally sponsored by Merck and Co. Inc., Whitehouse Station, NJ, USA. MHO, RBD, SEK and KW were investigators and RBD, HI, SEK and BD were steering committee members for the LIFE Study. BD, RBD and KW have received grant support from Merck and Co. Inc., the sponsor for the LIFE study. All of the authors (except ACKL) receive occasional speaker honoraria from Merck and Co. Inc.

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Larstorp, A., Okin, P., Devereux, R. et al. Changes in electrocardiographic left ventricular hypertrophy and risk of major cardiovascular events in isolated systolic hypertension: The LIFE study. J Hum Hypertens 25, 178–185 (2011). https://doi.org/10.1038/jhh.2010.52

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