Lawal Olutoyin Morenike, Enikuomehin Adenike, Otubogun Folajimi
Department of Internal Medicine, University of Medical Sciences Teaching Hospital Complex, Akure, Ondo State, Nigeria.
Department of Internal Medicine, University of Medical Sciences, Ondo, Ondo State, Nigeria.
Int J Gen Med. 2021 Apr 20;14:1421-1427. doi: 10.2147/IJGM.S282117. eCollection 2021.
Nigeria, like other developing nations, has an increasing burden of hypertension. Electrocardiography is an integral part of the diagnostic work-up for the newly diagnosed hypertensive subjects. The aim of this study was to determine the diagnostic yield of electrocardiography in hypertensive patients of a southwestern Nigerian hospital.
This was a retrospective descriptive study of electrocardiographs of hypertensive patients over a six-year period. Electrographic variables of interest were cardiac rhythm and rate, left ventricular hypertrophy (LVH), left atrial enlargement (LAE), T wave abnormalities, cardiac axis, blocks, complexes, QT segment abnormalities, atrial fibrillation (AF)/flutter, supraventricular tachycardia and pre-excitation syndrome. The Pearson's chi square was used to test for differences across age groups (15-44yrs, 45-64yrs and >65yrs) and between male and female subjects with the significance level set at 5% (< 0.05).
Hypertension was the indication for 40% of electrocardiographs completed and comprised of 3713 electrocardiograms (ECG) over a six-year period. The commonest abnormalities were left axis deviation (LAD) (32.2%), LVH (20.7%), rhythm abnormalities (16.7%) and LAE (14.5%). The diagnostic yield (presence of at least one electrographic abnormality) was 51% in 15-44 yrs age group, 64% in middle aged and 76.5% in the >65 yrs age group. While the male subjects in this study had a slightly increased likelihood of having an abnormal finding (odds ratio 1.18: 95% CI 1.02-1.35), the odds ratio for an abnormal ECG in subjects younger than 45 years was 0.48 (95% CI 0.41-0.57).
The diagnostic yield of electrocardiography in this study was considerable, although lowest in subjects younger than 45 years and increased with age. This may reflect an increased burden and earlier onset of hypertension and its complications. This should also engender prompt and aggressive management of hypertension, especially in the elderly in whom the cardiovascular complications from hypertension is most severe.
与其他发展中国家一样，尼日利亚高血压负担日益加重。心电图检查是新诊断高血压患者诊断评估的重要组成部分。本研究旨在确定尼日利亚西南部一家医院高血压患者心电图检查的诊断率。
这是一项对高血压患者六年期间心电图的回顾性描述性研究。感兴趣的心电图变量包括心律和心率、左心室肥厚（LVH）、左心房扩大（LAE）、T波异常、心电轴、传导阻滞、复合波、QT段异常、心房颤动（AF）/扑动、室上性心动过速和预激综合征。采用Pearson卡方检验来检测不同年龄组（15 - 44岁、45 - 64岁和>65岁）以及男性和女性受试者之间的差异，显著性水平设定为5%（<0.05）。
在六年期间，高血压是40%已完成心电图检查的指征，共3713份心电图（ECG）。最常见的异常是左偏心电轴（LAD）（32.2%）、LVH（20.7%）、心律异常（16.7%）和LAE（14.5%）。15 - 44岁年龄组的诊断率（至少存在一项心电图异常）为51%，中年组为64%，>65岁年龄组为76.5%。虽然本研究中的男性受试者出现异常发现的可能性略有增加（比值比1.18：95%可信区间1.02 - 1.35），但45岁以下受试者心电图异常的比值比为0.48（95%可信区间0.41 - 0.57）。
本研究中心电图检查的诊断率相当可观，尽管在45岁以下受试者中最低且随年龄增加。这可能反映了高血压负担增加及其并发症发病更早。这也应促使对高血压进行及时且积极的管理，尤其是在高血压心血管并发症最为严重的老年人中。
