Impact of left ventricular remodeling and renal function on 24 h-ECG recordings and cardiovascular outcome in elderly hypertensive patients

•High Lown's classes were more frequently observed in the presence of LVH.•Mean QTc was directly correlated with indexed LV mass.•SDNN was lower in patients with CKD compared to patients with preserved renal function.•DM, CKD, prolonged QTc, and SDNN < 96 ms were independent predictors of CV death at 2 years follow-up.

BackgroundThe prognostic role of left ventricular remodeling and renal function in elderly hypertensive patients has been so far scarcely investigated.AimsWe assessed the impact of left ventricular geometry and renal function on 24 h-Holter electrocardiogram (ECG) recordings and outcome in elderly hypertensive patients.MethodsWe enrolled 251 asymptomatic hypertensive elderly patients (> 65 year-old). Left ventricular remodeling was evaluated by 2-D echocardiogram. Lown's class, mean QTc and standard deviation of all normal R–R intervals (SDNN) were assessed by 24-h Holter-ECG recordings. Data on all-cause and cardiovascular mortality were collected for 2 years.ResultsMean age was 76.2 ± 11.4 years. High Lown's classes were more frequently observed in the presence of left ventricular hypertrophy (LVH) (57.3% vs. 23.7%; p < 0.001). Mean QTc was 444.8 ± 34.8 ms and resulted directly correlated with indexed left ventricular mass (r = 0.228; p = 0.001). Patients with Chronic Kidney Disease (CKD) showed lower SDNN as compared with those with preserved renal function (92.02 ± 36.11 ms vs. 103.84 ± 33.96 ms, respectively; p = 0.017). At 2 years, all-cause and cardiovascular mortality rates were 38.0% and 21.1%, respectively. Diabetes mellitus (HR: 2.40; 95% C.I.1.16 to 4.99; p = 0.019), CKD (HR: 2.22; 95% C.I.1.10 to 4.52; p = 0.028), prolonged QTc (HR: 2.18; 95% C.I.1.07 to 4.41; p = 0.030) and SDNN < 96 ms (HR: 1.98; 95% C.I.1.03 to 4.13; p = 0.048) were independent predictors of cardiovascular death at 2 year follow-up.ConclusionsCKD and left ventricular remodeling predicted altered ventricular batmotropism. Diabetes, CKD, heart rate variability and QTc are important predictors of cardiovascular death in elderly hypertensive patients.