Dataset Information

Long-term effects of chlorthalidone versus hydrochlorothiazide on electrocardiographic left ventricular hypertrophy in the multiple risk factor intervention trial.

ABSTRACT: Chlorthalidone (CTD) reduces 24-hour blood pressure more effectively than hydrochlorothiazide (HCTZ), but whether this influences electrocardiographic left ventricular hypertrophy is uncertain. One source of comparative data is the Multiple Risk Factor Intervention Trial, which randomly assigned 8012 hypertensive men to special intervention (SI) or usual care. SI participants could use CTD or HCTZ initially; previous analyses have grouped clinics by their main diuretic used (C-clinics: CTD; H-clinics: HCTZ). After 48 months, SI participants receiving HCTZ were recommended to switch to CTD, in part because higher mortality was observed for SI compared with usual care participants in H-clinics, whereas the opposite was found in C-clinics. In this analysis, we examined change in continuous measures of electrocardiographic left ventricular hypertrophy using both an ecological analysis by previously reported C- or H-clinic groupings and an individual participant analysis where use of CTD or HCTZ by SI participants was considered and updated annually. Through 48 months, differences between SI and usual care in left ventricular hypertrophy were larger for C-clinics compared with H-clinics (Sokolow-Lyon: -93.9 versus -54.9 ?V, P=0.049; Cornell voltage: -68.1 versus -35.9 ?V, P=0.019; Cornell voltage product: -4.6 versus -2.2 ?V/ms, P=0.071; left ventricular mass: -4.4 versus -2.8 g, P=0.002). At the individual participant level, Sokolow-Lyon and left ventricular mass were significantly lower for SI men receiving CTD compared with HCTZ through 48 months and 84 months of follow-up. Our findings on left ventricular hypertrophy support the idea that greater blood pressure reduction with CTD than HCTZ may have led to differences in mortality observed in the Multiple Risk Factor Intervention Trial.

SUBMITTER: Ernst ME

PROVIDER: S-EPMC3245686 | biostudies-literature | 2011 Dec

REPOSITORIES: biostudies-literature

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Long-term effects of chlorthalidone versus hydrochlorothiazide on electrocardiographic left ventricular hypertrophy in the multiple risk factor intervention trial.

Ernst Michael E ME Neaton James D JD Grimm Richard H RH Collins Gary G Thomas William W Soliman Elsayed Z EZ Prineas Ronald J RJ

Hypertension (Dallas, Tex. : 1979) 20111024 6

Chlorthalidone (CTD) reduces 24-hour blood pressure more effectively than hydrochlorothiazide (HCTZ), but whether this influences electrocardiographic left ventricular hypertrophy is uncertain. One source of comparative data is the Multiple Risk Factor Intervention Trial, which randomly assigned 8012 hypertensive men to special intervention (SI) or usual care. SI participants could use CTD or HCTZ initially; previous analyses have grouped clinics by their main diuretic used (C-clinics: CTD; H-cl ...[more]

PMID: 22025372

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Project description:BackgroundLeft ventricular hypertrophy (LVH) strongly predicts cardiovascular diseases (CVD) and death. One-fourth of Thai adults suffer from hypertension. Nevertheless, the information on LVH among Thai patients with hypertension is not well characterized. We aimed to identify the prevalence and factors associated with electrocardiographic LVH (ECG-LVH) among patients with hypertension in Thailand.MethodsThe present study obtained the dataset from the Thailand Diabetes Mellitus/Hypertension study, which included hypertension patients aged 20 years and older receiving continuous care at outpatient clinics in hospitals nationwide in 2011-2015 and 2018. Meanwhile, those without a record of 12-lead electrocardiography (ECG) were excluded from the analysis. ECG-LVH was defined as the LVH noted regarding ECG interpretation in the medical records. Multivariable logistic regression analysis was utilized for determining factors associated with ECG-LVH and presented as the adjusted odds ratio (AOR) and 95% confidence interval (CI).ResultsFrom 226,420 hypertensive patients in the Thailand Diabetes Mellitus/Hypertension study, 38,807 individuals (17.1%) with ECG data recorded were included in the analysis. The mean age was 64.8 ± 11.5 years, and 62.2% were women. Overall, 1,557 study participants had ECG-LVH, with an estimated prevalence of 4.0% (95% CI, 3.8-4.2%). Age-adjusted ECG-LVH prevalence among women and men was 3.4 and 5.1%, respectively (P < 0.001). Multivariable analysis determined factors associated with ECG-LVH, including being men (AOR, 1.49; 95% CI, 1.31-1.69), individuals aged 70 to 79 years (AOR, 1.56; 95% CI, 1.20-2.02) and ≥ 80 years (AOR, 2.10; 95% CI, 1.58-2.78) compared to individuals aged less than 50 years, current smokers (AOR, 1.26; 95% CI, 1.09-1.46) compared to those who never smoked, systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg (AOR, 1.58; 95% CI, 1.30-1.92) compared to systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg.ConclusionsThe current study illustrated the prevalence of ECG-LVH among Thai patients with hypertension who had ECG recorded and identified high-risk groups who tended to have ECG-LVH. The findings underscore the need for targeted interventions, particularly among high-risk groups such as older individuals, men, and current smokers, to address modifiable factors associated with ECG-LVH.

Project description:The electrocardiogram (ECG) is the most common tool used to predict left ventricular hypertrophy (LVH). However, it is limited by its low accuracy (<60%) and sensitivity (30%). We set forth the hypothesis that the Machine Learning (ML) C5.0 algorithm could optimize the ECG in the prediction of LVH by echocardiography (Echo) while also establishing ECG-LVH phenotypes. We used Echo as the standard diagnostic tool to detect LVH and measured the ECG abnormalities found in Echo-LVH. We included 432 patients (power = 99%). Of these, 202 patients (46.7%) had Echo-LVH and 240 (55.6%) were males. We included a wide range of ventricular masses and Echo-LVH severities which were classified as mild (n = 77, 38.1%), moderate (n = 50, 24.7%) and severe (n = 75, 37.1%). Data was divided into a training/testing set (80%/20%) and we applied logistic regression analysis on the ECG measurements. The logistic regression model with the best ability to identify Echo-LVH was introduced into the C5.0 ML algorithm. We created multiple decision trees and selected the tree with the highest performance. The resultant five-level binary decision tree used only six predictive variables and had an accuracy of 71.4% (95%CI, 65.5-80.2), a sensitivity of 79.6%, specificity of 53%, positive predictive value of 66.6% and a negative predictive value of 69.3%. Internal validation reached a mean accuracy of 71.4% (64.4-78.5). Our results were reproduced in a second validation group and a similar diagnostic accuracy was obtained, 73.3% (95%CI, 65.5-80.2), sensitivity (81.6%), specificity (69.3%), positive predictive value (56.3%) and negative predictive value (88.6%). We calculated the Romhilt-Estes multilevel score and compared it to our model. The accuracy of the Romhilt-Estes system had an accuracy of 61.3% (CI95%, 56.5-65.9), a sensitivity of 23.2% and a specificity of 94.8% with similar results in the external validation group. In conclusion, the C5.0 ML algorithm surpassed the accuracy of current ECG criteria in the detection of Echo-LVH. Our new criteria hinge on ECG abnormalities that identify high-risk patients and provide some insight on electrogenesis in Echo-LVH.

Dataset Information

Long-term effects of chlorthalidone versus hydrochlorothiazide on electrocardiographic left ventricular hypertrophy in the multiple risk factor intervention trial.

Publications

Long-term effects of chlorthalidone versus hydrochlorothiazide on electrocardiographic left ventricular hypertrophy in the multiple risk factor intervention trial.

Similar Datasets

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