Association of electrocardiographic left ventricular hypertrophy with cardiovascular events in hypertensive patients with and without chronic kidney disease

The relationship between left ventricular hypertrophy (LVH) and prognosis in hypertensive individuals has been reported, but the prognostic value of electrocardiographic LVH (ECG-LVH) in the presence or absence of chronic kidney disease (CKD) remains unclear. We retrospectively analyzed 697 hypertensive patients enrolled in the Japan Morning Surge Home Blood Pressure study. ECG-LVH was evaluated using the Sokolow–Lyon voltage (SL), Cornell product (CP), and RV5/V6 criteria, defined as the upper quartile. Echocardiographic LVH (echo-LVH) was defined as a left ventricular mass index >115 g/m² in men and >95 g/m² in women. The primary endpoint was a composite of major cardiovascular events. For predicting echo-LVH, sensitivities and specificities without CKD were 22% and 85% for SL, 40% and 83% for CP, and 31% and 76% for RV5/V6; with CKD, they were 23% and 90% for SL, 54% and 84% for CP, and 25% and 82% for RV5/V6. During a mean follow-up of 100 months, 76 primary events occurred. In Cox proportional hazards models adjusted for covariates, ECG-LVH in the patients without CKD was associated with hazard ratios (HRs) of 1.72 (95% CI: 0.91–3.26) for SL, 1.10 (0.57–2.12) for CP, and 0.96 (0.52–1.75) for RV5/V6. In the patients with CKD, the HRs were 3.08 (1.28–7.41) for SL, 0.90 (0.37–2.21) for CP, and 2.03 (0.82–5.02) for RV5/V6. The SL criterion was useful for predicting prognosis in hypertensive patients with CKD, although its sensitivity for the diagnosis of LVH was limited.