Nonspecific ST-T changes associated with unsatisfactory blood pressure control among adults with hypertension in China

Abstract

Nonspecific ST-segment and T-wave (ST-T) changes represent one of the most prevalent electrocardiographic abnormalities in hypertensive patients. However, a limited number of studies have investigated the association between nonspecific ST-T changes and unsatisfactory blood pressure (BP) control in adults with hypertension.The study population comprised 15,038 hypertensive patients, who were selected from 20,702 participants in the China Stroke Primary Prevention Trial. The subjects were examined with electrocardiogram test at the initial visit in order to monitor baseline heart activity. According to the results of the electrocardiogram (defined by Minnesota coding), the subjects were divided into 2 groups: ST-T abnormal and ST-T normal. Unsatisfactory BP control was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg following antihypertensive treatment during the 4.5-year follow-up period. Multivariate analysis was used to analyze the association between nonspecific ST-T abnormalities and unsatisfactory BP control.Nonspecific ST-T changes were common in hypertensive adults (approximately 8.5% in the study), and more prevalent in women (10.3%) and diabetic patients (13.9%). The unsatisfactory BP control rate was high in the total population (47.0%), notably in the ST-T abnormal group (55.5%). The nonspecific ST-T abnormal group exhibited a significantly greater rate of unsatisfactory BP control (odds ratio [OR] 1.20, 95% confidence interval [CI] [1.06, 1.36], P = 0.005]), independent of traditional risk factors, as demonstrated by multivariate regression analysis. Notable differences were further observed in male subjects (OR 1.51, 95% CI [1.17, 1.94], P = 0.002) and in patients with comorbid diabetes (OR 1.47, 95% CI [1.04, 2.07], P = 0.029).Greater rates of unsatisfactory BP control in hypertensive patients with electrocardiographic nonspecific ST-T abnormalities were observed, notably in the subcategories of the male subjects and the diabetic patients.

Nonalcoholic fatty liver disease, a potential risk factor of non-specific ST-T segment changes: data from a cross-sectional study

“…The prevalence of NST abnormalities was higher in females (4.5% vs 2.3% in males; P <0.001) among healthy volunteers (Hingorani et al, 2012), and similar findings were also observed in an Australian Busselton study (Cullen et al, 1982) and the Michigan study (Ostrander Jr. et al, 1965). One study proposed that NST changes were associated with a remarkably higher incidence rate of unsatisfactory blood pressure control in hypertension patients, especially among diabetic patients (Bao et al, 2017). Kumar et al also concluded that patients with high blood pressure tended to have NST changes (Kumar et al, 2008).…”

Electrocardiographic abnormalities among late-stage non-dialysis chronic kidney disease patients

“…CVD can kill patients with CKD more often and more prematurely. The CVD spectrum in CKD and ESRD includes ischemic attributed to displaced transition of QRS complex, 3) Absent Q waves in leads I, V5 and V6 or a narrow Q wave in the absence of myocardial pathology in the lead aVL, 4) R peak time greater than 60 ms in leads V5and V6 but normal in leads V1, V2 and V3, when small initial R waves can be discerned in the above leads, 5) ST and T waves opposite in direction to QRS, 6) Positive T wave in leads with upright QRS, 7) Depressed ST segment and/or negative T wave in leads with negative QRS [ Inverted T wave deeper than  mm [] Non-specific ST-T changes 1) No ST-T depression ≥ 0.5 mm but ST-segment down-sloping and ST-segment or T-wave nadir at least 0.5 mm below the P-R baseline in any of leads I, II, aVL, or V2 to V6 2) ST-J depression ≥1.0 mm and ST-segment up-sloping or U-shaped in any of leads I, II, aVL, or V1 to V6 3) T-wave amplitude zero (flat), negative, or diphasic (negative-positive type only) with <1.0 mm negative phase in leads I, II, aVL, or V3 to V6 when R-wave amplitude is ≥ 5.0 mm, 4) T-wave amplitude positive and T-to R-wave amplitude ratio of <1:20 in any of leads I, II, aVL, or V3 to V6 when R wave amplitude in the corresponding leads was ≥10.0 mm [46] Pathologic Q wave Any Q wave with more than  ms width or a depth more than one-third of the adjacent R wave in more than two adjacent leads [ heart disease, congestive heart failure, arrhythmias and peripheral vascular disease. Initially, it was estimated that this only occurred in the ESRD population which was 20-30 times more likely to die from CVD compared to the general population.…”

The Diagnostic Yield of Routine Electrocardiography in Hypertension and Implications for Care in a Southwestern Nigerian Practice

“…T wave abnormalities in hypertensive individuals have reportedly varied widely, from nonspecific T wave abnormality to strain T wave abnormality is a marker of LVH and it portends poor prognosis in hypertensive patients. 37,38 The diagnostic yield of ECG in the youngest age group was below 10% for most ECG abnormalities with the notable exceptions of LVH (14.5%), abnormal rhythm (18.9%), rate (17.3%) and axis deviation (15%). This may be attributable to shorter duration of hypertension and lower prevalence of hypertensive heart disease in this group.…”