Impact of Electrocardiographic Left Ventricular Hypertrophy on the Occurrence of Cardiovascular Events in Elderly Hypertensive Patients - The Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS)

Background: Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is a risk factor for cardiovascular events and the incidence of LVH increases with age. However, few studies have assessed risks associated with LVH in elderly hypertensive patients. Methods and Results: The Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS) was conducted to determine optimal blood pressure in elderly patients. At study entry, the sum of the S-wave in lead V-1 and the R-wave in lead V-5 (SV1+RV5) could be determined in 3,230 patients, among whom 164 (5.1%) had cardiovascular events. On univariate analysis, the hazard ratio for cardiovascular events was 1.51 for each 10 mm (=1 mV) (95% confidence interval (Cl): 1.34-1.69, P<0.0001) when SV1+RV5 was considered a continuous variable, and 2.17 (95%CI: 1.54-3.05, P<0.0001) and 2.83 (95%CI: 1.91-4.19, P<0.0001) when SV1+RV5 was classified into 2 groups at threshold values of either 35 mm or 40 mm, respectively. Multivariate Cox analysis showed that gender, age, current smoking, diabetes mellitus, history of renal disease, history of stroke, and SV1+RV5 were significantly related to the occurrence of cardiovascular events. Kaplan-Meier curves showed that increasing SV1+RV5 values were associated with higher incidences of cardiovascular events. Conclusions: ECG LVH is strongly related to cardiovascular events in elderly hypertensive patients. (Circ J 2010; 74: 938-945)