Showing papers by "Sverre E. Kjeldsen published in 2006"

Regression of Electrocardiographic Left Ventricular Hypertrophy and Decreased Incidence of New-Onset Atrial Fibrillation in Patients With Hypertension

Abstract: ContextAtrial fibrillation (AF) is associated with increased risk of mortality and cardiovascular events, particularly stroke, making prevention of new-onset AF a clinical priority. Although the presence and severity of electrocardiographic left ventricular hypertrophy (LVH) appear to predict development of AF, whether regression of electrocardiographic LVH is associated with a decreased incidence of AF is unclear.ObjectiveTo test the hypothesis that in-treatment regression or continued absence of electrocardiographic LVH during antihypertensive therapy is associated with a decreased incidence of AF, independent of blood pressure and treatment modality.Design, Setting, and ParticipantsDouble-blind, randomized, parallel-group study conducted in 1995-2001 among 8831 men and women with hypertension, aged 55-80 years (median, 67 years), with electrocardiographic LVH by Cornell voltage-duration product or Sokolow-Lyon voltage, with no history of AF, without AF on the baseline electrocardiogram, and enrolled in the Losartan Intervention for Endpoint Reduction in Hypertension Study.InterventionsLosartan- or atenolol-based treatment regimens, with follow-up assessments at 6 months and then yearly until death or study end.Main Outcome MeasureNew-onset AF in relation to electrocardiographic LVH determined at baseline and subsequently. Electrocardiographic LVH was measured using sex-adjusted Cornell product criteria ({RaVL + SV3 [+ 6 mm in women]} × QRS duration).ResultsAfter a mean (SD) follow-up of 4.7 (1.1) years, new-onset AF occurred in 290 patients with in-treatment regression or continued absence of Cornell product LVH for a rate of 14.9 per 1000 patient-years and in 411 patients with in-treatment persistence or development of LVH by Cornell product criteria for a rate of 19.0 per 1000 patient-years. In time-dependent Cox analyses adjusted for treatment effects, baseline differences in risk factors for AF, baseline and in-treatment blood pressure, and baseline severity of electrocardiographic LVH, lower in-treatment Cornell product LVH treated as a time-varying covariate was associated with a 12.4% lower rate of new-onset AF (adjusted hazard ratio [HR], 0.88; 95% CI, 0.80-0.97; P = .007) for every 1050 mm × msec (per 1-SD) lower Cornell product, with persistence of the benefit of losartan vs atenolol therapy on developing AF (HR, 0.83; 95% CI, 0.71-0.97; P = .01).ConclusionsLower Cornell product electrocardiographic LVH during antihypertensive therapy is associated with a lower likelihood of new-onset AF, independent of blood pressure lowering and treatment modality in essential hypertension. These findings suggest that antihypertensive therapy targeted at regression or prevention of electrocardiographic LVH may reduce the incidence of new-onset AF.

Identification and management of the hypertensive patient with elevated heart rate: statement of a European Society of Hypertension Consensus Meeting.

Abstract: IntroductionAlthough the association between elevated resting heart rate and cardiovascular morbidity and mortality has been demonstrated in a large number of epidemiologic studies, elevated heart rate is not yet considered to be a risk factor for cardiovascular disease. This is mainly due to the la

Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: The VALUE trial

Abstract: ContextType 2 diabetes is emerging as a major health problem, which tends to cluster with hypertension in individuals at high risk of cardiovascular disease.ObjectiveTo test for the first time the hypothesis that treatment of hypertensive patients at high cardiovascular risk with the angiotensin-rec

Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: An analysis of findings from the VALUE trial.

Abstract: Background In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial the primary outcome (cardiac morbidity and mortality) did not differ between valsartan and amlodipine-based treatment groups, although systolic blood pressure (SBP) and diastolic blood pressure reductions were significantly more pronounced with amlodipine. Stroke incidence was non-significantly, and myocardial infarction was significantly lower in the amlodipine-based regimen, whereas cardiac failure was non-significantly lower on valsartan. Objectives The study protocol specified additional analyses of the primary endpoint according to: sex; age; race; geographical region; smoking status; type 2 diabetes; total cholesterol; left ventricular hypertrophy; proteinuria; serum creatinine; a history of coronary heart disease; a history of stroke or transient ischemic attack; and a history of peripheral artery disease. Additional subgroups were isolated systolic hypertension and classes of antihypertensive agents used immediately before randomization. Methods The 15 245 hypertensive patients participating in VALUE were divided into subgroups according to baseline characteristics. Treatment by subgroup interaction analyses were carried out by a Cox proportional hazard model. Within each subgroup, treatment effects were assessed by hazard ratios and 95% confidence intervals. Results For cardiac mortality and morbidity, the only significant subgroup by treatment interaction was of sex (P U 0.016), with the hazard ratio indicating a relative excess of cardiac events with valsartan treatment in women but not in men, but SBP differences in favour of amlodipine were distinctly greater in women. No other subgroup showed a significant difference in the composite cardiac outcome between valsartan and amlodipine-based treatments. For secondary endpoints, a sex-related significant interaction was found for heart failure (P < 0.0001), with men but not women having a lower incidence of heart failure with valsartan. Conclusion As in the whole VALUE cohort, in no subgroup of patients were there differences in the incidence of the composite cardiac endpoint with valsartan and amlodipinebased treatments, despite a greater blood pressure decrease in the amlodipine group. The only exception was sex, in which the amlodipine-based regimen was more effective than valsartan in women, but not in men, whereas the valsartan regimen was more effective in preventing cardiac failure in men than in women. J Hypertens 24:2163‐ 2168 Q 2006 Lippincott Williams & Wilkins.

The Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) Trial: Outcomes in Patients Receiving Monotherapy

Abstract: In the main Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) report, we investigated outcomes in 15 245 high-risk hypertensive subjects treated with valsartan- or amlodipine-based regimens In this report, we analyzed outcomes in 7080 patients (464%) who, at the end of the initial drug adjustment period (6 months), remained on monotherapy Baseline characteristics were similar in the valsartan (N=3263) and amlodipine (N=3817) groups Time on monotherapy was 32 years (78% of treatment exposure time) The average in-trial blood pressure was similar in both groups Event rates in the monotherapy group were 16% to 39% lower than in the main VALUE trial In the first analysis, we censored patients when they discontinued monotherapy ("censored"); in the second, we counted events regardless of subsequent therapy (intention-to-treat principle) We also assessed the impact of duration of monotherapy on outcomes No difference was found in primary composite cardiac end points, strokes, myocardial infarctions, and all-cause deaths with both analyses Heart failure in the valsartan group was lower both in the censored and intention-to-treat analyses (hazard ratios: 063, P=0004 and 078, P=0045, respectively) Longer duration of monotherapy amplified between-group differences in heart failure New-onset diabetes was lower in the valsartan group with both analyses (odds ratios: 078, P=0012 and 082, P=0034) Thus, despite lower absolute event rates in monotherapy patients, the relative risks of heart failure and new-onset diabetes favored valsartan Moreover, these findings support the feasibility of comparative prospective trials in lower-risk hypertensive patients

Reductions in albuminuria and in electrocardiographic left ventricular hypertrophy independently improve prognosis in hypertension: the LIFE Study

Abstract: Reductions in albuminuria and in electrocardiographic left ventricular hypertrophy independently improve prognosis in hypertension : the LIFE study.

Impact of Diabetes Mellitus on Regression of Electrocardiographic Left Ventricular Hypertrophy and the Prediction of Outcome During Antihypertensive Therapy The Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study

Abstract: Impact of diabetes mellitus on regression of electrocardiographic left ventricular hypertrophy and the prediction of outcome during antihypertensive therapy : the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study.

Sympathetic Activity and Cardiovascular Risk Factors in Young Men in the Low, Normal, and High Blood Pressure Ranges

Abstract: We hypothesized that resting blood pressure is related to sympathetic activity in young men who are unaware of their blood pressure status in high, normal, and low ranges and that there is a relationship between sympathetic activity and coronary risk factors. Forty-three healthy, young men from the 1st [group 1, 106/52+/-2/2 mm Hg (+/-SEM), n=15], 50th (group 2, 129/79+/-2/1 mm Hg, n=15), and 98th to 99th percentile (group 3, 166/97+/-3/1 mm Hg, n=13) at a blood pressure screening were studied with intraarterial blood pressure, heart rate, and arterial plasma catecholamine responses to a mental, cold pressor, and orthostatic stress test. At baseline, group 3 had significant higher blood pressure (137/74+/-3/2 mm Hg) than group 2 (126/66+/-3/2 mm Hg; P<0.01) and group 1 (116/62+/-2/1 mm Hg; P<0.001). Group 1 had lower systolic blood pressure than group 2 (P=0.007). Baseline epinephrine and norepinephrine showed a clear positive linear trend (P<0.05), with the lowest values being in group 1 and highest in group 3. High-density lipoprotein was negatively related to epinephrine (r=-0.387; P=0.010). Mental stress was the only test that showed significant differences in cardiovascular and sympathetic responses among the groups, where group 3 had a more pronounced response in systolic and diastolic blood pressure and heart rate compared with group 1 (P<0.001) and group 2 (P<0.01). Furthermore, we found significant positive linear trends for Deltacatecholamines during mental stress across the groups (Deltaepinephrine P=0.001 and Deltanorepinephrine P=0.026, ANOVA). We conclude that resting blood pressure reflects both variation in resting arterial catecholamines and variation in cardiovascular and sympathetic responses specifically to mental stress.

Arterial plasma noradrenaline predicts left ventricular mass independently of blood pressure and body build in men who develop hypertension over 20 years.

Abstract: BackgroundIncreased sympathetic activity may be an underlying mechanism in cardiovascular disease. It has been hypothesized that the degree of left ventricular (LV) hypertrophy is partly related to the blood pressure level, and partly to neurohormonal factors. The aim of this study was to investigat

The angiotensin receptor antagonist valsartan: a review of the literature with a focus on clinical trials.

Abstract: Valsartan is an angiotensin receptor antagonist that specifically blocks the angiotensin II type 1 receptors. It is an effective and well-tolerated once-daily antihypertensive agent, with a tolerability profile similar to placebo. A recent series of large-scale clinical trials have shown the benefits of valsartan in disease states beyond hypertension. Based on the results of the Val-HeFT (Valsartan in Heart Failure Trial) and VALIANT (Valsartan in Acute Myocardial Infarction Trial) studies, valsartan is indicated for use in patients with heart failure and in patients post-myocardial infarction. Recently, in the VALUE (Valsartan Antihypertensive Long-term Use Evaluation) trial, valsartan was no more cardioprotective than calcium channel blockers, but was shown to reduce the risk of developing new-onset diabetes in hypertensive patients at high risk of cardiac events compared with calcium antagonist treatment. In diabetic patients with microalbuminuria, valsartan has been shown to have benefits beyond those...

N-terminal brain natriuretic peptide predicted cardiovascular events stronger than high-sensitivity C-reactive protein in hypertension: a LIFE substudy.

Abstract: BackgroundN-terminal pro-brain natriuretic peptide (Nt-proBNP) and high-sensitivity C-reactive protein (hsCRP) are cardiovascular risk markers in various populations, but are not well examined in hypertension. Therefore, we wanted to investigate whether high Nt-proBNP or hsCRP predicted the composit

Treatment of isolated systolic hypertension in diabetes mellitus type 2.

Abstract: Age-related arterial stiffness is more pronounced in diabetics compared to non-diabetics, which could explain the prevalence of isolated systolic hypertension (ISH, systolic blood pressure > or =140 mmHg and diastolic blood pressure <90 mmHg) being approximately twice that of the general population without diabetes. Large-scale interventional outcome trials have also shown that diabetics usually have higher pulse pressure and higher systolic blood pressure than non-diabetics. Advanced glycation end-product formation has been implicated in vascular and cardiac complications of diabetes including loss of arterial elasticity, suggesting possibilities for new therapeutic options. With increasing age, there is a shift to from diastolic to systolic blood pressure and pulse pressure as predictors of cardiovascular disease. This may affect drug treatment as different antihypertensive drugs may have differential effects on arterial stiffness that can be dissociated from their effects on blood pressure. While thiazide diuretics are associated with little or no change in arterial stiffness despite a robust antihypertensive effect, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and calcium-channel blockers have been shown to reduce arterial stiffness. However, combination therapy is nearly always necessary to obtain adequate blood pressure control in diabetics. There are no randomized controlled trials looking specifically at treatment of ISH in diabetics. Recommendations regarding treatment of ISH in diabetes mellitus type 2 are based on extrapolation from studies in non-diabetics, post-hoc analyses and prespecified subgroup analysis in large-scale studies, and metaanalysis. These analyses have clearly demonstrated that blood pressure lowering in ISH confers improved prognosis and reduced cardiovascular and renal outcomes in both diabetics and non-diabetics.

Mechanism of angiotensin II type 1 receptor blocker action in the regression of left ventricular hypertrophy.

Abstract: Left ventricular hypertrophy refers to a pathologic increase in left ventricular mass and is associated with an increased risk of subsequent cardiovascular morbidity and mortality from any cause. In the development of left ventricular hypertrophy there is growth of cardiomyocytes and accumulation of extracellular matrix and fibrosis. The actions are partly induced by angiotensin II, the principal effector of the renin-angiotensin-aldosterone system, binding to the AT1 receptor. Biochemical markers, some implicated in inflammatory changes, correlate with changes in left ventricular mass. The reduction in left ventricular mass brought about with angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ARB) therapy correlates with a reduction in these inflammatory changes, monitored by brain natriuretic peptide. Recent studies incorporating trials of ARBs have found ARBs to be more effective in reducing left ventricular mass than beta blockers and possibly more effective than calcium antagonists. Initial studies suggest that ARBs and angiotensin-converting enzyme inhibitors may have similar effects in terms of reducing left ventricular hypertrophy, and the combination of angiotensin-converting enzyme inhibitors and ARBs is thought to be synergistic due to a more complete inhibition of the renin-angiotensin-aldosterone system. In conclusion, these agents are efficacious in antihypertensive therapy and can play an important role in the prevention or regression of left ventricular hypertrophy due to hypertension.

The effect of antihypertensive agents on new-onset diabetes mellitus: time to amend the guidelines?

Abstract: Recent large hypertension trials have shown great differences in incidence of new-onset diabetes mellitus among patients receiving different antihypertensive drug therapies. The incidence of diabetes is unchanged or increased by the use of thiazide diuretics and β-adrenoceptor antagonists (β-blockers) and unchanged or decreased by ACE inhibitors, calcium channel blockers (CCBs), and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers). Recent results from ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) showed superiority of the ‘new’ combination of CCBs and ACE inhibitors over the ‘old’ or ‘conventional’ combination of β-blockers and diuretics. In this review, the results from some of the large hypertension trials are discussed, and the hypotheses on how different antihypertensive drug regimens can affect glucose homeostasis are considered. The question now is whether the results from these recent trials should affect the choice of antihypertensive treatment, particularly for special groups. However, the key goal is still to reduce BP, and this usually requires combinations of drugs.

Hypertension and cardiovascular disease in women: Progress towards better understanding of gender‐specific differences?

Abstract: There is an increasing recognition that there are gender specific characteristics of cardiovascular disease, the commonest cause of death in most developed countries [1,2]. Men and women differ con...

Is there an association between severe job strain, transient rise in blood pressure and increased mortality?

Abstract: Background. Job strain may be associated with various diseases and increased mortality but there is little data available from prospective studies with long‐term follow‐up. Objective. To assess the effect of heat exposure followed by severe job strain on blood pressure, heart rate and mortality. Design. Prospective 19‐year observational study (1982–2000) of a cohort of employees in a ferry alloy plant undergoing two economical crises. The participants were 218 healthy males aged 30–59 years. Measurements. Annual standardized measurements of blood pressure, heart rate, serum cholesterol and registration of morbidity and mortality. Results. Heat‐exposed men (n = 25) and non‐heat‐exposed men (n = 193) had unchanged blood pressure from 1982 to 1984. Thereafter the plant underwent two serious economic crises, in 1985–87 and 1990–91, respectively. The first one was handled by decisions exclusively taken by the head office and included a gradual lay‐off of 25% of the workers, and the second one was handled joint...

Does long-term losartan- vs atenolol-based antihypertensive treatment influence collagen markers differently in hypertensive patients? A LIFE substudy.

Abstract: Background. The aim of this study was to investigate the effect of losartan‐ vs atenolol‐based antihypertensive treatment on circulating collagen markers beyond the initial blood pressure (BP) reduction. Methods. In 204 patients with hypertension and left ventricular (LV) hypertrophy we measured serum concentration of carboxy‐terminal telopeptide of type I procollagen (ICTP), carboxy‐terminal propeptide of type I procollagen (PICP), amino‐terminal propeptide of type III procollagen (PIIINP), amino‐terminal propeptide of type I procollagen (PINP) and LV mass by echocardiography at baseline and annually during 4 years of losartan‐ or atenolol‐based antihypertensive treatment; 185 patients completed the study. Results. Beyond the first year of treatment systolic and diastolic BP, LV mass index (LVMI) as well as collagen markers did not change significantly and were equal in the two treatment groups. Changes in PICP during first year of treatment were related to subsequent changes in LV mass index after 2 and...

European Society of Hypertension Scientific Newsletter: Update on Hypertension Management: Prevention of type 2 diabetes mellitus with antihypertensive drugs.

Abstract: Epidemiology and pathophysiology in elderly and old patients Hypertension in the elderly (those over the age of 65 years) is an increasing public health concern [1]. Raised blood pressure, especially systolic pressure, confers a significant cardiovascular risk and should be actively treated in elderly patients, at least up to the age of 80 years. Even in the very old, (those above the age of 80 years) hypertension is a dominant risk factor, although it is yet unclear whether treatment prolongs life, even if it prevents stroke and heart failure. The prevalence of hypertension approaches or even exceeds 50% in people aged 70 and above [2]. Most elderly people with hypertension have isolated systolic hypertension, defined as systolic pressure greater than 140 mm Hg and diastolic pressure less than 90 mm Hg [3, 4]. Systolic hypertension is a more potent risk factor than increases in diastolic pressure. Sluggish baroreceptor function and reduced cardiovascular sensitivity to catecholamines make the elderly more sensitive to natural or drug-induced falls in blood pressure.

Scintigraphic demonstration of myocardial perfusion and ischaemia associated with coronary artery bypass grafting.

Abstract: Objectives. To assess if myocardial perfusion scintigraphy (MPS) at rest can be of value in elucidating myocardial perfusion, ischaemia and perioperative myocardial infarction (PMI) associated with coronary artery bypass graft (CABG) surgery. Design. This was a prospective randomized study of patients undergoing elective CABG. Forty-eight patients in the control group underwent serial ECG recordings and measurements of CK-MB and cTnT. Fifty-four patients in the study group were additionally examined with MPS preoperatively and 2–4 days and 6 weeks postoperatively. Results. The study showed a highly significant (p < 0.001) improvement in myocardial radionuclide uptake from preoperatively to 2–4 days postoperatively. Judged from ECG and enzymatic changes, two control patients and one study patient only had PMI and no additional cases of PMI were demonstrated by MPS. Conclusion. MPS at rest showed that CABG significantly improved myocardial perfusion, by demonstrating an increase in radionuclide uptake. In d...

Are all the hypertensives made equal

Abstract: Blood pressure lowering in hypertensive patients is of significant importance. The complex pathophysiology makes the therapeutic targets many, and extensive research has provided us with many antihypertensive drugs. However, data indicate that the proportion of patients with controlled blood pressure is far from satisfying. This may partly be explained by a lack of individualized treatment. Present guidelines for management of hypertension emphasize that a thorough evaluation of the patient is necessary before initiating treatment. Based on information about gender, age, ethnicity, family history, clinical examination and concomitant diseases like diabetes mellitus, coronary heart disease, heart failure, cerebrovascular disease and gout, the physician is able to provide the best treatment. However, most patients need two to three drugs to control the blood pressure. Thus, we need methods to predict blood pressure responses to the various drugs in the individual patients. Possibly, in the future treatments may be based upon genetic variants. Until now, several polymorphisms in genes regulating blood pressure have been located, and these may influence responses to drugs. However, the results are heterogeneous and contradictory, and we are yet not capable of determining the best treatment based on genetic properties. Coming years challenge us to further clarify these potentially important aspects of treatment. Meanwhile, physicians are obligated to individualize the treatment by other means, based on disease history, concomitant diseases and clinical examination.

RAAS inhibition--a practice of medical progress.

Abstract: The therapeutic utility of inhibiting the RAAS remains one of the major therapeutic successes in cardiovascular medicine over the past decades [1].The angiotensin‐converting enzyme (ACE) inhibitors...

Long-term effects of a losartan- compared with an atenolol-based treatment regimen on carotid artery plaque development in hypertensive patients with left ventricular hypertrophy: ICARUS, a LIFE substudy.

Abstract: In the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study, there was a 25% risk reduction for stroke with angiotensin receptor blocker-based therapy (losartan) as compared with β-blocker-based therapy (atenolol) despite comparable blood pressure reductions. This substudy examines treatment effects on the amount and density of atherosclerotic lesions in the common carotid arteries and the carotid bulb in 81 patients during 3 years of treatment. There were no statistically significant changes in the amount of carotid plaque in patients treated with losartan compared with an atenolol-based treatment program. A statistically nonsignificant increase in plaque density and index (average of plaque amount and density) was seen in the atenolol group compared with those treated with losartan. The small number of patients evaluated may have limited the power to detect a difference in outcome. The difference in carotid plaque index increase between the treatment groups during 3 years of treatment could not be statistically linked to specific treatments in the present substudy.

An American TROPHY in the prevention of hypertension.

Abstract: The common nomenclature used for the blood pressure range between normal and clearly hypertensive levels has shifted from transient hypertension (the 1940s) to borderline hypertension (the 1970s), ...

Beta-blockers as sub-optimal treatment for hypertension: time for first-line therapy revision?

Abstract: Recent evidence provides growing support to earlier observations by Messerli et al. [1] that beta‐blockers might not offer optimal cardiovascular protection for patients with uncomplicated essentia...

ESH statement on detection and punishment of abstract fraud and poster plagiarism.

Abstract: The European Meeting on Hypertension was organized for the 15th time in Milan in June 2005. Every second meeting takes place in Milan; after the record turnout of more than 8000 delegates at the 14...

Cost-effectiveness of blood pressure measurement and hypertension follow-up.

Abstract: Hypertension‐attributable cardiovascular mortality amounts to almost 3 million yearly deaths worldwide (5.8% of total deaths), which represents more than 17.5 million years of life lost (YLLs) [1]....

Treatment of hypertension in patients with congestive cardiac failure.

Abstract: Hypertension is a major risk factor for the development of cardiac failure. Patients with severe heart failure and left ventricular ejection fraction <40% are excluded from the majority of hypertension trials. The European Guidelines recommend treatment of hypertension in patients with heart failure and the introduction of blood pressure-lowering drugs that deal with the underlying disease. Several of the drugs may be needed in combination to achieve target blood pressure.

Abstract 1881: Association of New-Onset Left Bundle Branch Block with Cardiovascular Morbidity and Mortality in Hypertensive Patients with Left Ventricular Hypertrophy: The LIFE study

Abstract: Background : Whether new-onset left bundle branch block (LBBB) is associated with increased cardiovascular morbidity and mortality in treated hypertensive patients is unknown. Object : To assess cardiovascular morbidity and mortality associated with new-onset LBBB in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study among hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH). Methods: Hypertensive patients with LVH by Cornell voltage-duration product or Sokolow-Lyon voltage criteria on screening electrocardiograms were randomized to a mean of 4.8 years of losartan- or atenolol-based treatment. electrocardiograms were read at a central laboratory; Minnesota code 7.1 identified LBBB. Only participants without LBBB on LIFE study baseline electrocardiograms were included in the current study. Results : The electrocardiograms in LIFE study annual follow-up evaluations identified 296 patients (143 or 48.3% women) with and 8277 patients (4458 or 53.9% women) without new-onset LBBB. New-onset LBBB was associated with older age (70.0±6.2 vs. 67.3±7.0 years), higher sex-adjusted Cornell voltage (30.7±7.9 vs. 27.2±7.1) and higher prevalence of cardiovascular disease (35.8% vs. 24.2%)(all p Conclusion: Among hypertensive patients with electrocardiographic LVH, new-onset LBBB independently identifies those at increased risk of developing subsequent congestive heart failure and myocardial infarction.