| Electrocardiographic left ventricular hypertrophy contributes to the risk of stroke and long-term prognosis in patients with strokeBackground:Stroke is associated with great morbidity and mortality, in each year, more than 2.5 million Chinese have stroke. This is partly due to the poor recognition and poor control of risk factors of stroke, especially in rurul areas. Electrocardiographic left ventricular hypertrophy which is a measure of hypertensive target organ damage in heart, has been reported to be associated with increased morbidity and mortality of cardiovascular disease. However, little data are available concerning about the association between the electrocardiographic left ventricular hypertrophy and the risk of stroke, and the results are inconsistent.Objectives:The purpose of this study was to evaluate whether electrocardiographic left ventricular hypertrophy (LVH) contributes to the risk of stroke and long-term prognosis of stroke patients in Chinese.Methods:The stroke patients and control subjects were recruited from 7 clinical centers located in 7 provinces from the same demographic area and at the same time from 2000 to 2001. Only 3 subtypes of stroke-cerebral atherosclerosis, lacunar infarction, and intracerebral hemorrhage-were included. Diagnosis of stroke was based on strict neurological examination, computed tomography, or MRI according to the International Classification of Diseases,9th revision. Controls were selected from inpatients with minor illness from the departments of ophthalmology, gastroenterology, otorhinolaryngology, and orthopedics and from community-based inhabitants free of neurological diseases, following the same exclusion criteria as patients. Then the patients with stroke were followed up by standard questionnaire. Cox proportional-hazards models were used to examine the association between LVH and long-term cerebrocardiovascualr adverse events. Electrocardiographic LVH was defined by standard voltage criteria reported by Sokolow and Lyon. The long-term cardiovascular adverse events included non-fatal myocardial infarction, the recurrence of stroke and cerebral cardiovascular death.Results:A total of 1874 stroke patients and 1879 controls were recruited, the mean age were 60.5±9.5 years and 59.5±8.7 years, the rate of male were 66.9% and 61.7% respectively. Cerebral thrombosis, lacunar infarction, intracerebral hemorrhagea were 854 (45.6%),500 (26.7%) and 520 (27.7%), respectively. The levels of the age, systolic blood pressure, diastolic blood pressure, fasting blood sugar, triglycerine were significantly elevated in stroke (P<0.01) while total cholesterol and high density lipoprotein cholesterol were significantly decreased. After adjustment for sex, age, body mass index and conventional vascular risk factors, LVH was associated with evaluated risk of 2.2-fold (95% confidence interval [CI] 1.6～3.0, P<0.001) for overall stroke,2.2-fold (95% CI 1.6～3.1, P<0.001) for cerebral thrombosis,1.8-fold (95% CI 1.2～2.7,P<0.001) for lacunar infarction,2.0-fold (95% CI 1.3-3.0, P<0.001) for intracerebral hemorrhagea. The mean follow-up was 3.7±1.4 years,392 cerebral cardiovascular adverse events were observed during the follow-up. After adjustment for sex, age, body mass index and conventional vascular risk factors, LVH was associated with evaluated risk of 1.36-fold (95%CI 1.14～1.76, P<0.05) for long-term adverse cardiovascular events, and 1.37-fold (95%CI 1.04-1.83, P<0.05) for all cause death.Conclusions:Electrocardiographic left ventricular hypertrophy is not only an independent risk factor for stroke, but also an independent predictor for poor prognosis of stroke. Hypertension in Young Adult:Etiology, Targeted Organ Damage and TreatmentBackgrounds Hypertension in the young adult may lead to the early onset of cerebral cardiovascular disease and premature risk of death and disability, but it is poorly elucidated in developing countries.Methods We investigated the causal profile, antihypertensive therapy in the patients between 16 to 30 years old who were hospitalized with arterial hypertension in Fuwai hospital between 2002 to 2008.Results Totally 309 patients were enrolled. Essential hypertension and secondary hypertension were diagnosed in 59.9%(185/309) and 38.8% (120/309) respectively. Renovascular hypertension is the leading cause for secondary hypertension and Takayasu's arteritis is the leading cause for renovascular hypertension. In Essential hypertensive,57.8% of the patients presented with at least one component of metabolic syndrome, much higher than that in secondary hypertensives (9.2%, p<0.01), comparable in the targeted organ damage between essential and secondary hypertensives (32.4% vs 29.2%, p>0.05). Resistant hypertension was found in 55.7%(172/309) of the patients, secondary hypertension, obesity, underutilization of diuretics were the main causes for resistant hypertension.Conclusion We concluded that almost half young hypertensives can be identified to have treatable causes for their hypertension. Young essential hypertensives have more frequent metabolic abnormalities which are the important contributors to hypertension and resistant to antihypertensive treatment. |
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