Context: Electrocardiographic left ventricular hypertrophy (LVH) is a strong p redictor of cardiovascular(CV) morbidity and mortality. However, the predictive value of changes in the magnitude of electrocardiographic ...Context: Electrocardiographic left ventricular hypertrophy (LVH) is a strong p redictor of cardiovascular(CV) morbidity and mortality. However, the predictive value of changes in the magnitude of electrocardiographic LVH criteria during an tihypertensive therapy remains unclear. Objective: To test the hypothesis that l esser severity of electrocardiographic LVH during antihypertensive treatment is associated with decreased CV morbidity and mortality, independent of blood press ure levels and reduction and treatment modality. Design, Setting, and Participan ts: Double-blind, randomized, parallel-group study conducted in 1995-2001 amo ng 9193 men and women with hypertension aged 55 through 80 years(mean, 67 years) , with electrocardiographic LVH by Cornell volt-age-duration product or Sokolo w-Lyon voltage criteria and enrolled in the Losartan Intervention For Endpoint Reduction in Hypertension(LIFE) study. Interventions: Losartan-or atenolol-bas ed treatment regimens, with follow-up assessments for at least 4(mean, 4.8 [SD, 0.9]) years. Main Outcome Measure: Composite end point of CV death, myocardial infarction(MI), or stroke in relation to severity of electrocardiographic LVH de termined at baseline and on subsequent electrocardiograms obtained at 1 or more annual revisits. Results: Cardiovascular death, nonfatal MI, or stroke occurred in 1096 patients (11.9%). In Cox regression models controlling for treatment ty pe, baseline Framingham risk score, baseline and in-treatment blood pressure, a nd severity of baseline electrocardiographic LVH by Cornell product and Sokolow -Lyon voltage, less-severe in-treatment LVH by Cornell product and Sokolow-L yon voltage were associated with 14%and 17%lower rates, respectively, of the c omposite CV end point(adjusted hazard ratio[HR], 0.86; 95%confidence interval[C I], 0.82-0.90; P< .001 for every 1050-mm ×ms[1-SD] decrease in Cornell produ ct; and HR, 0.83; 95%CI, 0.78-0.88; P< .001 for every 10.5-mm[1-SD] decrease in Sokolow-Lyon voltage). In parallel analyses, lower Cornell product and Soko low-Lyon voltage were each independently associated with lower risks of CV mort ality (HR, 0.78; 95%Cl, 0.73-0.83; P< .001; and HR, 0.80; 95%CI, 0.73-0.87; P< .001, respectively), MI(HR, 0.90; 95%CI, 0.82-0.98; P=.01; and HR, 0.90; 95 %CI, 0.81-1.00; P=.04), and stroke(HR, 0.90; 95%CI, 0.84-0.96; P=.002; and H R, 0.81; 95%CI, 0.75-0.89; P< .001). Conclusions: Less-severe electrocardiogr aphic LVH by Cornell product and Sokolow-Lyon voltage criteria during antihyper tensive therapy is associated with lower likelihoods of CV morbidity and mortali ty, independent of blood pressure lowering and treatment modality in persons wit h essential hypertension. Antihypertensive therapy targeted at regression or pre vention of electrocardiographic LVH may improve prognosis.展开更多
文摘Context: Electrocardiographic left ventricular hypertrophy (LVH) is a strong p redictor of cardiovascular(CV) morbidity and mortality. However, the predictive value of changes in the magnitude of electrocardiographic LVH criteria during an tihypertensive therapy remains unclear. Objective: To test the hypothesis that l esser severity of electrocardiographic LVH during antihypertensive treatment is associated with decreased CV morbidity and mortality, independent of blood press ure levels and reduction and treatment modality. Design, Setting, and Participan ts: Double-blind, randomized, parallel-group study conducted in 1995-2001 amo ng 9193 men and women with hypertension aged 55 through 80 years(mean, 67 years) , with electrocardiographic LVH by Cornell volt-age-duration product or Sokolo w-Lyon voltage criteria and enrolled in the Losartan Intervention For Endpoint Reduction in Hypertension(LIFE) study. Interventions: Losartan-or atenolol-bas ed treatment regimens, with follow-up assessments for at least 4(mean, 4.8 [SD, 0.9]) years. Main Outcome Measure: Composite end point of CV death, myocardial infarction(MI), or stroke in relation to severity of electrocardiographic LVH de termined at baseline and on subsequent electrocardiograms obtained at 1 or more annual revisits. Results: Cardiovascular death, nonfatal MI, or stroke occurred in 1096 patients (11.9%). In Cox regression models controlling for treatment ty pe, baseline Framingham risk score, baseline and in-treatment blood pressure, a nd severity of baseline electrocardiographic LVH by Cornell product and Sokolow -Lyon voltage, less-severe in-treatment LVH by Cornell product and Sokolow-L yon voltage were associated with 14%and 17%lower rates, respectively, of the c omposite CV end point(adjusted hazard ratio[HR], 0.86; 95%confidence interval[C I], 0.82-0.90; P< .001 for every 1050-mm ×ms[1-SD] decrease in Cornell produ ct; and HR, 0.83; 95%CI, 0.78-0.88; P< .001 for every 10.5-mm[1-SD] decrease in Sokolow-Lyon voltage). In parallel analyses, lower Cornell product and Soko low-Lyon voltage were each independently associated with lower risks of CV mort ality (HR, 0.78; 95%Cl, 0.73-0.83; P< .001; and HR, 0.80; 95%CI, 0.73-0.87; P< .001, respectively), MI(HR, 0.90; 95%CI, 0.82-0.98; P=.01; and HR, 0.90; 95 %CI, 0.81-1.00; P=.04), and stroke(HR, 0.90; 95%CI, 0.84-0.96; P=.002; and H R, 0.81; 95%CI, 0.75-0.89; P< .001). Conclusions: Less-severe electrocardiogr aphic LVH by Cornell product and Sokolow-Lyon voltage criteria during antihyper tensive therapy is associated with lower likelihoods of CV morbidity and mortali ty, independent of blood pressure lowering and treatment modality in persons wit h essential hypertension. Antihypertensive therapy targeted at regression or pre vention of electrocardiographic LVH may improve prognosis.
