Heart, Lung and Circulation

Prevalence of Atrial Fibrillation and Left Ventricular Hypertrophy in the Valsartan Intensified Primary Care Reduction of Blood Pressure (VIPER-BP) Study Cohort

      Background: There are few large-scale studies of the prevalence of atrial fibrillation (AF) and left ventricular hypertrophy (LVH) in hypertensive individuals being managed in primary care; both are poor prognostic markers in this clinical setting.
      Methods: VIPER-BP is a multicentre, open-label, randomised controlled trial in GP clinics throughout Australia comparing usual GP management with an intensive blood pressure (BP) management strategy using three forms of valsartan-based therapy. As part of baseline profiling, 2035 12-lead ECGs (96% of patients) were subject to blinded Minnesota coding.
      Results: There were 1212 (60%) men and 823 women (mean age 68 and 73 years, respectively). Mean baseline systolic/diastolic BP in men and women respectively was 154/91 and 151/89 mm Hg. A similar proportion of men (n = 15, 1.2%, 95% CI 0.8–2.0%) and women (n = 8, 0.97%, 95% CI 0.50–1.9%) were in AF (1.1% overall). Compared to the rest, men and women with AF were older (mean age 68 and 73 vs. 60 and 58 years) and had higher mean resting heart rates (77 and 75 vs. 71 and 69 bpm); p < 0.001 all comparisons. Alternatively, more men (n = 115, 9.5%, 95% CI 8.0–11.3%) than women (n = 28, 3.4%, 95% CI 2.4–4.9%) had ECG evidence of LVF (7.0% overall). Men with LVF were younger (mean age 56 vs. 58 years) and had higher mean BP's (155/92 vs. 152/91 mm/Hg) while women were older (mean age 63 vs. 60 years) and had higher systolic BP (155/88 vs. 151/89 mm/Hg).
      Conclusion: These data highlight the utility of ECG screening in hypertensive patients to detect evidence of advanced forms of heart disease requiring active treatment.