From the Guidelines
High blood pressure can cause significant changes on an electrocardiogram (ECG), primarily due to the development of left ventricular hypertrophy (LVH), and controlling blood pressure with lifestyle modifications and medications, such as ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics, is crucial to prevent or reverse these changes and reduce cardiovascular risk. When blood pressure remains elevated over time, the left ventricle must work harder to pump blood against higher resistance, leading to LVH, which is a secondary manifestation of hypertension and independently predicts future cardiovascular disease (CVD) events 1. This thickening of the heart muscle appears on an ECG as increased QRS complex voltage, left axis deviation, and sometimes ST segment depression and T wave inversion, although electrocardiographic criteria for LVH correlate weakly with echocardiographic or MRI definitions of LVH and are less strongly related to CVD outcomes 1. Other ECG changes may include prolonged QT intervals and signs of atrial enlargement, and hypertension also adversely impacts other echocardiographic markers of cardiac structure and function, including left atrial size and diastolic function 1. Regular blood pressure monitoring and ECG screening are important for people with hypertension to detect these changes early, and assessment of LVH by means of echocardiography or MRI is most useful in adults who are young or have evidence of secondary hypertension, chronic uncontrolled hypertension, or history of symptoms of heart failure 1. Controlling blood pressure can prevent or even reverse some ECG abnormalities, reducing the risk of serious cardiovascular complications like heart failure, stroke, and heart attacks, and BP lowering leads to a reduction in LV mass, with the long-acting diuretic chlorthalidone being slightly more effective in reducing LVH than other medications in some studies 1. Key considerations for managing high blood pressure and ECG changes include:
- Monitoring blood pressure regularly to detect any changes or increases
- Using medications such as ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics to control blood pressure
- Making lifestyle modifications, such as diet and exercise changes, to help manage blood pressure
- Regular ECG screening to detect any changes or abnormalities
- Considering echocardiography or MRI to assess LVH in certain individuals, such as those with secondary hypertension or chronic uncontrolled hypertension 1.
From the FDA Drug Label
Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure. The primary endpoint was the first occurrence of cardiovascular death, nonfatal stroke, or nonfatal myocardial infarction. Treatment with losartan resulted in a 13% reduction (p=0. 021) in risk of the primary endpoint compared to the atenolol group; this difference was primarily the result of an effect on fatal and nonfatal stroke.
The treatment of high blood pressure with losartan can help reduce the risk of cardiovascular events, including stroke and myocardial infarction.
- ECG changes are not directly addressed in the provided text as being affected by losartan.
- The effect of losartan on ECG changes in patients with high blood pressure is not explicitly stated in the drug label. 2 2
From the Research
High Blood Pressure and ECG Changes
- High blood pressure can lead to various cardiovascular complications, including heart failure and changes in electrocardiogram (ECG) readings 3.
- The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure guideline provides updated recommendations for antihypertensive medication initiation and intensification, which can help reduce the risk of cardiovascular disease (CVD) events 3.
- Studies have shown that certain antihypertensive medications, such as angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs), can help reduce blood pressure and improve cardiovascular outcomes in patients with heart failure 4, 5.
- However, these medications can also have adverse effects, such as coughing, skin rash, and hyperkalemia, which can impact their tolerability and effectiveness 4, 6.
- Calcium channel blockers (CCBs) are another class of antihypertensive medications that can help reduce blood pressure and improve cardiovascular outcomes, with some studies suggesting that they may be more effective than ACEIs in certain patient populations 7, 6.
- The choice of antihypertensive medication should be individualized based on patient characteristics, comorbidities, and other factors, with the goal of achieving optimal blood pressure control and reducing the risk of cardiovascular complications 3, 5.
ECG Changes and Antihypertensive Medications
- ECG changes can occur in patients with high blood pressure, particularly those with left ventricular hypertrophy or heart failure 3.
- Certain antihypertensive medications, such as ARBs and ACEIs, can help reduce the risk of ECG changes and improve cardiovascular outcomes in patients with heart failure 4, 5.
- However, the relationship between ECG changes and antihypertensive medications is complex, and further research is needed to fully understand the effects of these medications on cardiac function and ECG readings 3, 5.
Clinical Outcomes and Antihypertensive Medications
- Clinical outcomes, such as heart failure hospitalization and all-cause mortality, can be improved with the use of antihypertensive medications, particularly ARBs and ACEIs 4, 5.
- Sacubitril-valsartan, a combination of an ARB and a neprilysin inhibitor, has been shown to improve clinical outcomes in patients with heart failure and reduced ejection fraction 5.
- The choice of antihypertensive medication should be based on individual patient characteristics, comorbidities, and other factors, with the goal of achieving optimal blood pressure control and reducing the risk of cardiovascular complications 3, 5.