The presence of a strain wave pattern (ST depression and T-wave inversion) on electrocardiography is an independent predictor for new-onset congestive heart failure in adults being treated for hypertension, according to an article in the January 3rd issue of Circulation.

The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study involved 8,696 hypertensive patients with left ventricular hypertrophy per ECG but no history of heart failure. After randomization to an atenolol-based or losartan-based antihypertension regimen, they were followed for an average of 4.7 years.

A strain pattern on ECG was found in 923 patients (10.6 percent). These patients had a greater than three-fold increased risk of developing congestive heart failure, with a five-year rate of 8.8 percent compared with only 2.7 percent for those without strain. Additionally, patients with strain had an exactly four-fold increased risk of mortality due to heart failure, with a five-year mortality of 1.2 percent compared with only 0.3 percent in patients without strain.

"These findings suggest that more aggressive therapy may be warranted in hypertensive patients with ECG strain to reduce the risk of congestive heart failure (CHF) and CHF mortality," said Peter Okin, MD, the study's lead investigator and lead author.

The ECG strain pattern was first identified in 1949. The pattern has previously been strongly associated with left ventricle hypertrophy independently of coronary heart disease and with an increased risk of cardiovascular morbidity and mortality in heart patients.

Compared with patients who did not develop heart failure, patients who developed heart failure were older; more likely to be black; more likely to have diabetes and a prior history of ischemic heart disease, myocardial infarction, stroke, and peripheral vascular disease; more overweight; and more likely to be current smokers. The study found that after adjusting for these factors, presence of strain was still associated with increased risk of congestive heart failure.