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European Heart Journal Advance Access published online on August 17, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp321
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

QRS duration predicts sudden cardiac death in hypertensive patients undergoing intensive medical therapy: the LIFE study

Daniel P. Morin1, Lasse Oikarinen2, Matti Viitasalo2, Lauri Toivonen2, Markku S. Nieminen2, Sverre E. Kjeldsen3, Björn Dahlöf4, Majnu John5, Richard B. Devereux6 and Peter M. Okin6,*

1 Division of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA
2 Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
3 Department of Internal Medicine, Ullevål University Hospital, Oslo, Norway
4 Department of Internal Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden
5 Department of Public Health, Weill Cornell Medical College, New York, NY, USA
6 Greenberg Division of Cardiology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA

Received 25 September 2008; revised 3 July 2009; accepted 23 July 2009 * Corresponding author. Tel: +1 212 746 2150, Fax: +1 212 746 8473, Email: pokin{at}med.cornell.edu

Aims: To determine whether QRS duration predicts sudden cardiac death (SCD) in patients with left ventricular hypertrophy and treated hypertension.

Methods and results: Over 4.8 ± 0.9 years follow-up of 9193 hypertensive patients with electrocardiographic evidence of LVH who were treated with atenolol- or losartan-based regimens, 178 patients (1.9%) suffered SCD. In multivariable analysis including randomized treatment, changing blood pressure over time, and baseline differences between patients with and without SCD, QRS duration was independently predictive of SCD (HR per 10 ms increase = 1.22, P < 0.001). Baseline QRS duration remained a significant predictor of SCD even after controlling for the presence or absence of left bundle branch block (HR = 1.17, P = 0.001) and for changes in ECG LVH severity over the course of the study (HR = 1.16, P = 0.017).

Conclusion: In the setting of aggressive antihypertensive therapy, prolonged QRS duration identifies hypertensive patients at higher risk for SCD, even after controlling for left bundle branch block, other known risk factors for SCD, and changes in blood pressure and severity of left ventricular hypertrophy.

Key Words: Hypertension • Left ventricular hypertrophy • QRS duration • Sudden cardiac death


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