RESTING ELECTROCARDIOGRAM ABNORMALITIES IN PATIENTS WITH ARTERIAL HYPERTENSION AND THEIR ASSOCIATION WITH CARDIOVASCULAR RISK FACTORS
Authors: Bendoudouch Houssam , Dahmani Ikram , Mahdi Zaynab , Benali Mehdi , Ouadfel Oussama , Dhimene Safae , Mhani Hafida , Najib Anas , Berhil Taha , Lahnin Fadoua , Soussan Ilias , Hara Loubna , Boussaad Pr Badr , Najdi Pr Adil , Raisso Pr Zainab 
Published: June 2022

Objective:

Study the socio-epidemiological aspects of hypertensive patients in the North of Morocco, analyze the prevalence of electrocardiogram abnormalities, and find an association between the presence of the abnormalities and both the age of hypertension and other cardiovascular risk factors.

Methods: This work is based on a study of 300 out of 1108 patients who consulted the Cardiology Department of the Tangier. The study also includes 50 Control subjects. Data consisted of anamnesis, clinical examination & an electrocardiogram. All data was collected through a survey.

Design and method:

The mean age was 60,23 [40;93]. The sex ratio was 0.38 (72,3% F, 27,8%M). The patients with obesity (BMI> 30 kg/m2) were at 24%. The mean duration of the arterial hypertension was 5,77 years [1;32]. They take the same medication for hypertension for 4,14 years [1;17]. The mean heart rate of our study group is 77,13 b/min [49;112]. 13,7% have left heart axis. 19 patients have a PR interval superior to 200ms. Conduction abnormalities were observed in 10,3%.17% have Left Ventricular Hypertrophy. The voltage Cornell index was the most positive in patients with LVH (60,78%). Rhythm abnormalities were found in 18 subjects (6%). Repolarization disorders were observed in a total of 37 (12,3%) patients. 64,7% take only one HTN-specific medication, while 33,7 % take 2. 49,3% of our study group are treated with Calcium Channel blockers, represented by Amlodipine. The second most frequent medication is ACE inhibitors (30%) (Ramipril (55,7%)), followed by Angiotensin Receptor blockers at 26,7% (Losartan (80%). 35 % of our patients presented ECG abnormalities. LVH was the most prevalent anomaly (34%), Hypertensive patients present significantly more ECG abnormalities than controls (p < 0,018) (OR: 2,45). Patients with ECG abnormalities have a higher mean of years of HTN (6,59) than those with a normal resting ECG (5,32) (p < 0,021). Patients with LVH (7,29) have a higher mean of years of HTN than patients who do not have LVH (5.45) p < 0.027. The presence of more cardiovascular risk factors (other than HTN) increases the risk of ECG anomalies by 2,21. There is no significant association between the presence of other CVRF and the existence of electrical LVH (p = 0,275).

Conclusion: To our knowledge, this is the first characterization of hypertensive patients in Morocco since 2000. Arterial hypertension is associated with more frequent electrocardiogram abnormalities, especially with Left ventricular hypertrophy. It also increases the frequency of these anomalies in comparison to non-hypertensive patients. ECG findings are correlated to the age of HTN. Other cardiovascular risk factors increase the ECG abnormalities, thus influence the prognosis of the hypertension.