Prognostic value of non-specific ST-T changes and left ventricular hypertrophy electrocardiographic criteria in hypertensive patients: 16-year follow-up results from the MINACOR cohort

BACKGROUND: Non-specific electrocardiographic ST-T wave changes and voltage criteria for left ventricular hypertrophy (LVH) have been associated with cardiovascular morbidity and mortality. The aim of the cohort study was to evaluate the prognostic value of non-specific ST-T changes and LVH electrocardiographic criteria on cardiovascular events and mortality in hypertensive patients. METHODS: A cohort study of 352 non-diabetic hypertensive patients, without associated cardiovascular disease, randomly selected from 1,780 hypertensive patients attended in a primary care center. An electrocardiogram was performed at the baseline visit (classified according to the Minnesota Code). Cardiovascular events and death from any cause during the follow-up period were evaluated. A multivariate analysis adjusted for gender, age and cardiovascular risk factors was performed. RESULTS: Data of 273 patients were analyzed: 58.2% women, age 44.1 (7.9) years, 27.8% smokers, blood pressure at baseline 142.7 (15.3)/89.3 (9.6) mmHg. During the 197.5 (59.24) month follow-up, 62 patients (22.7%) had a cardiovascular event. On multivariate analysis, age, systolic blood pressure, incidence of diabetes, smoking and electrocardiographic LVH criteria (HR 2.66 [CI 95% 1.39 - 5.10]), were significantly associated with cardiovascular events, but the presence of non-specific ST-T abnormalities (HR 0.97 [CI 95% 0.49 -1.90]) was not significantly associated with cardiovascular morbidity and mortality. CONCLUSIONS: Hypertensive patients with LVH electrocardiographic criteria have significantly higher cardiovascular mortality and morbidity, but non-specific electrocardiographic ST-T changes are not associated with cardiovascular morbidity and mortality.