Revista de hipertensión: acceso abierto

Determinants of Left Ventricular Hypertrophy in Hypertensive Patients seen in a Teaching Hospital in Ghana

Abstract

Owusu Isaac Kofi and Acheamfour-Akowuah Emmanuel

Hypertensive heart disease presenting as left ventricular hypertrophy (LVH) is a common and potentially modifiable cardiovascular risk factor often overlooked in most sub-Saharan African countries including Ghana. This cardiac marker occurring in hypertension is very important because it affects the overall cardiovascular disease risk assessment and management. We sought to assess the prevalence and determinants of electrocardiographic left ventricular hypertrophy in patients with hypertension seen at the outpatient clinic of a Teaching Hospital in Ghana. A cross-sectional and prospective study was conducted on three hundred and fifty hypertensive patient at Komfo Anokye Teaching Hospital in Kumasi, Ghana. Following informed consent, a questionnaire was used to gather demographic, anthropometric and clinical details of patients. A standard resting 12-lead resting ECG was performed on all the study participants and Scott's criteria was used to determine LVH. Fischer's exact test for statistical significance at 95% confidence interval was used to evaluate associations between categorical variables. Various independent associations with LVH were also assessed using logistic regression analysis. P value of 0.05 was considered as statistically significant. The mean (± standard deviation) age of the patients was 59.65 ± 13.52 years. The mean systolic and diastolic blood pressures were 141.76 ± 20.26 mmHg, 84.28 ± 10.49 mmHg respectively; and the body mass index was 27.5 ± 6.09 kg/m2. The prevalence of electrocardiographic left ventricular hypertrophy (ECG-LVH) among the hypertensive patients was 46.6%. When multiple logistic regression analysis was done, male gender (adjusted OR: 2.40, 95% CI 1.53-3.78, P=0.000), cigarette smoking (adjusted OR: 0.34, 95% CI 0.12-0.95, P=0.040) elevated SBP (adjusted OR: 1.79, 95% CI 1.09-2.93, P=0.200) and uncontrolled BP (adjusted OR: 1.86, 95% CI 1.15- 3.01, P=0.011) emerged as independent determinants of left ventricular hypertrophy. In conclusion, LVH is a common pre-clinical cardiac complication in Ghanaian individuals with hypertension. Male gender, cigarette smoking, elevated systolic blood pressure and uncontrolled BP appear to be the main determinants of this important pre-clinical cardiac damage.