RESUMEN
UNLABELLED: FUNDAMENTALS AND OBJECTIVE: Electrocardiographic voltage criteria are the preferred method for diagnosis of left ventricular hypertrophy (LVH) in Primary Health Care (PHC). Several of these have been described as major adverse cardiovascular events (MACE) predictors. The aim of this study was to analyse the relationship between MACE occurrence in a cohort of hypertensive subjects in PHC and different electrocardiographic criteria recorded. PATIENTS AND METHODS: 265 hypertensive subjects attending PHC were randomly selected and followed up for 12 years. Standard 12-lead electrocardiograms were recorded at the beginning of the study. The occurrence of ischemic heart disease, heart failure, stroke, peripheral vascular disease, arrhythmia or cardiovascular death was considered as MACE. Electrocardiographic voltage criteria recorded were: Sokolow-Lyon, Minnesota code 3.1, Gubner and Ungerleider, Cornell voltage and Schillaci and Dalfó modifications. Data were analyzed using the life-table method and Cox regression models. RESULTS: 14,3% of patients lost to follow-up showed no differences in baseline characteristics from the rest of the cohort. The median follow-up was 10.1 years (IQR: 5.8-12.0). The cumulative survival rate was 53.5% (95% CI, 45.7-61.3%). The incidence of MACE was 5.85 (95% CI, 4.73-6.97) per 100 hypertensive patients-year. In the multivariate analysis none of the ECG criteria showed statistical association with the occurrence of MACE. CONCLUSIONS: No association has been found between different electrocardiographic LVH criteria and the incidence of MACE in a cohort of hypertensive patients followed-up in a PHC setting for 12 years.
Asunto(s)
Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Electrocardiografía , Hipertensión/complicaciones , Hipertrofia Ventricular Izquierda/complicaciones , Hipertrofia Ventricular Izquierda/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de SaludRESUMEN
INTRODUCTION AND OBJECTIVES: Numerous hospital studies have shown that different left ventricular (LV) geometric patterns have different effects on cardiovascular risk. The aims of this study were to estimate the risk of major adverse cardiovascular events (MACEs) in hypertensive patients seen in primary care and to identify any association with LV geometric pattern. METHODS: In total, 265 hypertensive subjects attending primary care were randomly selected and followed up for 12 years. Those with cardiovascular disease, secondary hypertension, complete bundle branch block or electrocardiographic signs of ischemic heart disease were excluded. The LV geometric pattern was characterized as either concentric hypertrophy, eccentric hypertrophy, concentric remodeling or normal. A MACE was the occurrence of ischemic heart disease, heart failure, stroke, peripheral vascular disease, arrhythmia or cardiovascular death. Data were analyzed using the life-table method and Cox regression modeling. RESULTS: Although 14% of patients were lost to follow-up, their baseline characteristics were similar to those of patients who completed the study. The cumulative survival rate was 56.3% (95% confidence interval [CI], 49.8%-62.8%). The incidence of MACEs was 4.67 (95% CI, 3.79-5.55) per 100 subject-years. Moreover, the incidence was similar in the four LV geometric pattern groups (P=.889). Only age (hazard ratio [HR]=1.03; 95% CI, 1-1.05) and the presence of diabetes at study entry (HR=1.67; 95% CI, 1.03-2.69) were associated with an increased risk of a MACE. CONCLUSIONS: In the study population, only age and diabetes at study entry were associated with the occurrence of a MACE. There was no evidence for an association between MACEs and the LV geometric pattern.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Hipertensión/epidemiología , Hipertensión/terapia , Hipertrofia Ventricular Izquierda/etiología , Hipertrofia Ventricular Izquierda/mortalidad , Función Ventricular Izquierda/fisiología , Anciano , Enfermedades Cardiovasculares/fisiopatología , Estudios de Cohortes , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/mortalidad , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , España/epidemiologíaRESUMEN
OBJECTIVES: To evaluate the degree of control of blood pressure (BP) in the autochthonous and immigrant populations and to find the variables linked to good control. DESIGN: Cross-sectional, observational study. SETTING: Urban primary care team, Spain. PARTICIPANTS: All patients with hypertension seen between 1/1/2000 and 1/7/2005 and whose origin was known: 1.063 patients in all, 931 autochthonous and 132 immigrant ones. MAIN MEASUREMENTS: The main variable was hypertension control the last time BP was taken (BP =140/90 mm Hg and =130/80 mm Hg in diabetics). In addition, data on country of origin, age, gender, body mass index, cardiovascular risk factors (diabetes, lipaemia, tobacco dependency), further examinations (annual blood analysis and ECG every 2 years) and prescribed medication were recorded. Logistic regression was used to calculate the effect of origin on blood pressure monitoring. RESULTS: Good BP control was achieved in 39.2% of autochthonous patients and 25% of immigrants (odds ratio [OR], 1.6; 95% confidence interval [CI], 95% CI, 1.2-2.1). Nevertheless, multivariate analysis indicated age (OR, 1.029; 95% CI, 1.017-1.040) as the sole factor determining good or bad BP control. CONCLUSIONS: The origin of the patient does not affect BP control.