Hypertension

• Patient assessment- brief overview

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• Guidelines
• New Zealand Guidelines: Threshold for Pharmacologic Treatment
• New Zealand Guidelines: Emerging Risk Factors
• Selected Information From JNC 7

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• Left Ventricular Hypertrophy
• LVH on ECG and prognosis
• LVH with echo and prognosis
• Africans have more LVH
• LVH- more information

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• Hypertension Trials
• Beta-blockers no longer first or second line agents for treatment of hypertension for all patients.
• Review of Hypertension trials- 2005
• ASCOT, LIFE, ALLHAT, ANBP2

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• Ambulatory and Home BP Monitoring
• Introduction

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• Lifestyle Measures
• Impact on Hypertension

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• Resistant Hypertension
• Meet the experts session- ESC 2008

Hypertension and Left Ventricular Hypertrophy

Assessed with ECGs

Impact on Prognosis

The predictive value for cardiovascular events of different methods for detecting ECG-LVH One study (J Am Coll Cardiol 1998; 31:383-90) found that a new score, the Perugia score not only classified more hypertensives as having LVH, but also remained an independent predictor of cardiovascular events in multivariate analysis (hazard ratio 2.04). The Framingham ECG method also remained an independent predictor (hazard ratio 1.91) but classified fewer patients has having ECG-LVH than the Perugia score (5.2% vs 17.8%).

In other words, the Perugia score correctly identified more patients that were at increased risk. However, intuitively, given that both methods had roughly the same hazard ratio (about 2), one might conclude that the absolute risk of adverse events for those identified by the Framingham method is higher than those identified by the Perugia score. Additionally, those identified as not having left ventricular hypertrophy by the Framingham method will also be at higher risk than those without left ventricular hypertrophy by the Perugia method!

That is, if we try to stratify risk further on the basis of presence or absence of ECG-LVH then I think, intuitively, the above study suggests:

• those without LVH by the Perugia score are at lower absolute risk
• those with LVH by the Perugia score are at intermediate absolute risk
• those with LVH by the Framingham method are at higher absolute risk

Hitesh Patel, Cardiologist
12th August, 2004