The necessity for recognition and treatment of patients with "mild" hypertension

High-amplitude QRS complex in the electrocardiograms of normotensive people and risk of subsequent hypertension

BACKGROUND

Left ventricular hypertrophy sometimes develops in normotensive people with a genetic background for hypertension. The aim of this case-control study was to test the hypothesis that a high-amplitude QRS complex (high-QRS) is indicative of risk of eventual hypertension.

METHODS

We reviewed medical charts that included blood pressure data obtained every 6 months from 7011 Japanese workers. The cases were all of 24 normotensive people showing an electrocardiogram with SV1+RV5>4.0 mV (high-QRS). The 24 controls chosen presented normal electrocardiograms and were matched for blood pressure, body mass index, age, gender, glycated hemoglobin A1c fraction, and parental occurrence of hypertension. The incidence of hypertension and change in blood pressure during a 5-year study period were compared in the two groups.

RESULTS

The cases were more likely than the controls to have a parent with hypertension (18/24 [75.0%] and 686/5704 [12.0%], respectively; P<0.01, odds ratio=21.8 [95% CI: 8.6-55.2]). At the end of the study period, hypertension was more frequent (18/24 [75.0%] and 3/24 [12.5%], respectively; P<0.01, odds ratio=21.0 [95% CI; 4.6-96.2]) and both systolic and diastolic blood pressures were higher (149.0+/-17.1 mmHg vs. 139+/-17.1 mmHg, P<0.01; and 89.5+/-9.2 mmHg vs. 81.7+/-11.5 mmHg, P=0.01, respectively) in the cases than in the controls.

CONCLUSIONS

High-QRS may be indicative of risk of eventual hypertension, and may therefore be useful for screening purposes.

Department of Veterans Affairs hypertension meeting : a proposal for improved care

A major invitational hypertension meeting was hosted by the Department of Veterans Affairs (VA) in Washington, DC, on May 26 to 28, 1999. It followed a report that only 25% of hypertensive veterans had adequate levels of treated blood pressure and focused on how control of hypertension could be improved both immediately and in the future. After the presentation of brief outlines of 5 unresolved basic science questions, 2 general topics were considered: (1) 30 years of change in hypertension and its treatment and (2) current healthcare delivery mechanisms and how to improve them. Since 1970, the severity of hypertension has decreased, malignant hypertension has disappeared, and the prognostic roles of systolic and diastolic blood pressure have been reversed as hypertension became milder. Five VA Cooperative Studies have provided important data: the 1970 Freis Trial report demonstrated the value of treatment, 2 trials showed that some controlled patients can decrease or even discontinue pharmacological treatment without recrudescent hypertension, a blinded trial was performed on the efficacy of different antihypertensive drugs, and an unblinded trial showed that diuretics and beta-blockers are the most effective agents when caregivers choose the agent and dose. Two healthcare models were considered: (1) the patient-friendly VA Hypertension Screening and Treatment Program that was introduced in 1972, which controls 80% of patients at the goal of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure with diuretics and keeps patients in the program an average of 7.5 years, and (2) the newer primary care health maintenance organization-like model in the VA and throughout the United States. Choosing a regimen and monitoring control of blood pressure and compliance with therapy were discussed. The meeting was closed with 6 general recommendations for improving the care of hypertensive patients.