Prevalence and factors associated with left ventricular hypertrophy among patients with newly diagnosed arterial hypertension in mulago hospital.

Abstract

BACKGROUND: Left ventricular hypertrophy (LVH) is an early cardiac manifestation of target organ damage in hypertensive patients, its presence being a marker of other target organ involvement. It is a major independent and reversible predictor of increased morbidity and mortality in hypertensive patients. Various factors such as arrhythmias, cardiac dysfunction, obesity and diabetes have been associated with LVH, all contributing to increased morbidity and mortality. LVH regression is therefore a potential therapeutic target in hypertensive patients that may impact significantly on morbidity and mortality associated with HTN. OBJECTIVE: This study sought to determine the prevalence and factors associated with LVH among newly diagnosed hypertensive patients in mulago hospital, a community in which hypertension is a major cause of cardiovascular morbidity. METHODS: This was a cross-sectional study carried out among newly diagnosed hypertensive out-patients referred to the hypertension clinic of mulago hospital. A Total of 120 patients were consecutively recruited and administered with a questionnaire in order to obtain demographic characteristics, reason for attending hospital at time of diagnosis as well as some symptoms that have been attributed to hypertension in previous studies. Weight, height, pulse and blood pressure were then measured followed by electrocardiogram and echocardiogram to screen for LVH and associated cardiac abnormalities. ECG tracings were interpreted with the help of a cardiologist. The prevalence of LVH among the study participants was determined by both ECG and ECHO criteria and associations between LVH and clinical, echocardiographic and electrocardiographic findings sought of. RESULTS: Prevalence of LVH among newly diagnosed hypertensive subjects in mulago hospital was 76.7%. Palpitations withordinary exertion, recurrent headaches and dizziness were common symptoms among hypertensive patients being present in over 50% of all subjects. Diastolic dysfunction at echocardiography was likewise prevalent. This was sound in 66.3% of all subjects with LVH or over half of all newly diagnosed hypertensive subjects. Ischemic ECG changes were also common among patients with LVH being present in 43% of these subjects. This was significantly associated with LVH as diagnosed by Sokolow-Lyon criteria. CONCLUSION: The prevalence of LVH was high among newly diagnosed hypertensive patients. This represents s a large proportion of hypertensive patients who are at a significantly higher risk of cardiovascular morbidity and mortality when compared to hypertensive subjects without LVH. This also reflects on delayed diagnosis of hypertension such that hypertensive patients are already manifesting with target organ damage at diagnosis. Target organ damage in the form of LVH if further complicated by diastolic dysfunction and ischemic ECG changes in a significant proportion of these individuals. Symptoms of recurrent headache and palpitations with ordinary exertion appeared to result in hypertensive established before development of LVH. The sentitivity and specificity of the Sokolow-Lyons and Cornell voltage in detecting LVH are low emphasising the importance of simple echocardiographic measurements of the left ventricular posterior wall and inter-ventricular septum thickness if LVH is to be correctly detected in order to risk stratify hypertensive patients.