Abstract
Introduction
The electrocardiogram (ECG) is listed among the routine diagnostic examinations for hypertensive patients according to international guidelines.
Objective
The aim of this survey was to investigate whether an ECG is routinely prescribed before an echocardiographic examination by general practitioners for the evaluation of subclinical cardiac damage in uncomplicated hypertensive patients in a suburban area of Italy.
Methods
A total of 60 consecutive hypertensive patients (45 % men, mean age 60 ± 14 years) referred to a single out-patient cardiology service by their general practitioners for the assessment of cardiac organ damage by echocardiography were enrolled in the study. Patients’ demographic data and medical history were collected at the echocardiographic laboratory on a questionnaire administered by the attending physician.
Results
Less than 40 % of the study sample had undergone an ECG during the 12-month period preceding the echocardiographic examination. Notably, only 60 % of newly diagnosed hypertensive patents had an ECG done after the discovery of their hypertensive status.
Conclusions
These findings show that an ECG is not routinely prescribed as a first-line examination in the assessment of cardiac organ damage related to hypertension by a large fraction of general practitioners in current clinical practice in a northern area of Italy. This contrasts with available evidence that the combined assessment of left ventricular hypertrophy by ECG and echocardiogram provides the best evaluation of cardiac damage and stratification of cardiovascular risk in hypertension.
Similar content being viewed by others
References
Levy D, Salomon M, D’Agostino RB, Belager AJ, Kannel WB. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation. 1994;90:1786–93.
Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001;141:334–41.
Bombelli M, Facchetti R, Carugo S, Madotto M, Arenare F, Quarti-Trevano F, et al. Left ventricular hypertrophy increases cardiovascular risk independently of in- and out-of office blood pressure values. J Hypertens. 2009;27:2458–64.
Mathew J, Sleight P, Lonn E, Johnstone D, Pogue J, Yi Q, et al. Heart Outcomes Prevention Evaluation (HOPE) Investigators. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation. 2001;104:1615–21.
Pierdomenico SD, Cuccurullo F. Risk reduction after regression of echocardiographic left ventricular hypertrophy in hypertension: a meta-analysis. Am J Hypertens. 2010;23:876–81.
Larstop AC, Okin PM, Devereux RB, Olsen MH, Ibsen H, Dahlof B, et al. Regression of ECG-LVH is associated with lower risk of new onset heart failure and mortality in patients with isolated systolic hypertension: the LIFE study. Am J Hypertens. (epub 21 June 2012).
Costanzo P, Savarese G, Rosano G, Musella F, Casaretti L, Vassallo E, et al. Left ventricular hypertrophy reduction and clinical events: a meta-regression analysis of 14 studies in 12,809 hypertensive patients. Int J Cardiol. (epub 12 Jun 2012).
The Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report. JAMA 2003; 289: 2560–2572.
Guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87.
Pewsner D, Juni P, Egger M, Battaglia M, Sundstrom J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007;335:771–5.
Cuspidi C, Ambrosioni E, Mancia G, Pessina AC, Trimarco B, Zanchetti A, on behalf of the APROS Investigators. Role of echocardiography and carotid ultrasonography in stratifying risk in patients with essential hypertension: the assessment of prognostic risk observational survey. J Hypertens. 2002;20:1307–14.
Schillaci G, de Simone G, Reboldi G, Porcellati C, Devereux RB, Verdecchia C. Change in cardiovascular risk profile by echocardiography in low- or medium-risk hypertension. J Hypertens. 2002;20:1519–25.
Nardi E, Palermo A, Mulè G, Cusimano P, Cerasola G, Rini GB. Prevalence and predictors of left ventricular hypertrophy in hypertensive patients with normal electrocardiogram. Eur J Prev Cardiol. (epub 3rd May 2012).
Cuspidi C, Negri F, Giudici V, Capra A, Muiesan ML, Agabiti-Rosei E, de Simone G, et al. Echocardiography in clinical practice: the burden of arterial hypertension—a multicenter Italian survey. J Hum Hypertens. 2010;24:395–402.
Devereux RB, Reickek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977;55:613–8.
Verdecchia P, Angeli F, Gattobigio R, Sardone M, Porcellati C. Asymptomatic left ventricular systolic dysfunction in essential hypertension: prevalence, determinants, and prognostic value. Hypertension. 2005;45:412–8.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.
Cuspidi C, Michev I, Lonati L, Vaccarella A, Cristofari M, Garavelli G, et al. Compliance to hypertension guidelines in clinical practice: a multicentre pilot study in Italy. J Hum Hypertens. 2002;16:699–703.
Cuspidi C, Valerio C, Sala C, Muiesan ML, Grandi AM, Palumbo G, et al. The Hyper-Pract : a multicentre survey on the accuracy of the echocardiographic assessment of hypertensive left ventricular hypertrophy in clinical practice. Blood Press. 2008;17:124–8.
Cuspidi C, Rescaldani M, Sala C, Negri F, Grassi G, Mancia G. Prevalence of electrocardiographic left ventricular hypertrophy in human hypertension: an updated review. J Hypertens. 2012;30:2066–73.
Sundstrom J, Lond L, Arnlov J, Zethelius B, Andren B, Lithell HO. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men. Circulation. 2001;103:2346–51.
Gerdts E, Okin PM, Borman K, Wacthtell K, Nierminen MS, Dahlof B, Devereux RB. Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy. Am J Hypertens. 2012;25:678–83.
Cuspidi C, Meani S, Valerio C, Fusi V, Sala C, Zanchetti A. Left ventricular hypertrophy and cardiovascular risk stratification: impact and cost-effectiveness of echocardiography in recently diagnosed essential hypertensives. J Hypertens. 2006;24:1671–7.
Acknowledgments
The authors are grateful to Dr. Francesca Negri (MD) for her contribution to the statistical analysis. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest that are directly relevant to the content of this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cuspidi, C., Re, A., Dell’Oro, R. et al. The Neglected Role of the Electrocardiogram in the Diagnostic Work-Up of Hypertensive Patients. High Blood Press Cardiovasc Prev 20, 39–43 (2013). https://doi.org/10.1007/s40292-013-0003-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40292-013-0003-6