Electrocardiographic Findings in Hypertension

Main Electrocardiographic Findings

The European Society of Cardiology recommends that electrocardiography (ECG) is used to detect left ventricular hypertrophy (LVH) in hypertensive patients, with a sensitivity of 10-20% in Caucasians 1, 2
The American Heart Association suggests that the Sokolow-Lyon index (SV1 + RV5 or RV6 >3.5 mV or >38 mm) is a commonly used voltage criterion for diagnosing LVH 1, 3
The European Society of Cardiology states that the Cornell voltage (RaVL >1.1 mV) and Cornell product (voltage Cornell × QRS duration >2440 mm*ms) are also useful for diagnosing LVH 1, 3

The European Society of Cardiology notes that the sensitivity of ECG for detecting LVH is low (10-20% in hypertensive patients with LVH), but specificity is high (85-90%) 4, 1
Echocardiography is more sensitive than ECG for diagnosing LVH 2

The American College of Cardiology recommends that marked repolarization abnormalities (ST depression, T wave inversion) are indicative of more severe LVH and higher cardiovascular risk in hypertensive patients 4, 5
The European Society of Cardiology suggests that these abnormalities are unusual in hypertensive Caucasians with simple LVH, but when present, indicate more severe LVH and higher cardiovascular risk 4, 5

The European Society of Cardiology states that left atrial enlargement may be the earliest ECG sign of hypertensive heart disease, even before LVH appears 1
Left atrial enlargement is associated with increased risk of atrial fibrillation, cardiovascular disease, and death 1

The European Society of Cardiology notes that conduction abnormalities and pathological Q waves are unusual in hypertensive Caucasians without other pathology 4
Atrial fibrillation is common, affecting approximately one-third of hypertensive patients 4

The European Society of Cardiology recommends that ECG findings favoring simple hypertension (not hypertrophic cardiomyopathy) include a normal ECG or isolated voltage increase without repolarization abnormality 4
Regression of LVH with strict blood pressure control (<130 mmHg) for 6-12 months also favors simple hypertension 4

The American Heart Association states that LVH detected by ECG is an independent predictor of cardiovascular events in observational studies and clinical trials, particularly in patients >55 years old 1, 3
Regression of left ventricular mass assessed by ECG predicts lower risk of major cardiovascular events 8, 5

The European Society of Cardiology recommends that a 12-lead ECG should be part of the routine evaluation of all hypertensive patients 1, 2, 3
Early detection of atrial fibrillation on ECG facilitates prevention of stroke through appropriate anticoagulation 3