Symptoms associated with an abnormal echocardiogram in elderly primary care hypertension patients

L Ringoir,V J Pop,J M Keyzer,S S Pedersen,J W Widdershoven

doi:10.1007/s12471-014-0543-y

Abstract

BackgroundThe prevalence and diagnostic value of heart failure symptoms in elderly primary care patients with hypertension is unknown.AimTo assess the prevalence, sensitivity, specificity, positive and negative predictive value of symptoms in association with an abnormal echocardiogram.Design and settingCross-sectional screening study in five general practices in the south-east of the Netherlands.MethodBetween June 2010 and January 2013, 591 primary care hypertension patients aged between 60 and 85 years were included, without known heart failure and not treated by a cardiologist. All patients underwent an echocardiogram and a structured interview including assessment of heart failure symptoms: shortness of breath, fatigue, oedema, cold extremities, and restless sleep.Results and conclusionRestless sleep was reported by 25 %, cold extremities by 23 %, fatigue by 19 %, shortness of breath by 17 %, and oedema by 13 %. Oedema was the only symptom significantly associated with an abnormal echocardiogram (positive predictive value was 45 %, sensitivity 20 %, and specificity 90 %, OR 2.12; 95 % CI = 1.23–3.64), apart from higher age (OR 1.06; 95 % CI = 1.03–1.09), previous myocardial infarction (OR 3.00; 95 % CI = 1.28–7.03), and a systolic blood pressure of >160 mmHg (OR 1.62; 95 % CI = 1.08–2.41). Screening with echocardiography might be considered in patients with oedema.

Highlights

Hypertension is highly prevalent, with the Framingham study showing a lifetime risk for developing hypertension of 90 % in people with a normal blood pressure at age 55 [1]
Oedema was the only symptom significantly associated with an abnormal echocardiogram, apart from higher age, previous myocardial infarction, and a systolic blood pressure of >160 mmHg
The current study shows that regular restless sleep was reported by 25 %, having cold extremities by 23 %, fatigue by 19 %, shortness of breath by 17 %, and oedema of legs, ankles and/ or feet by 13 %

Summary

Introduction

Hypertension is highly prevalent, with the Framingham study showing a lifetime risk for developing hypertension of 90 % in people with a normal blood pressure at age 55 [1]. More severe hypertension in primary care patients is associated with a higher risk of cardiovascular events [9], and lowering blood pressure can reduce risk of major cardiovascular events [10]. Elderly hypertension patients, Neth Heart J (2014) 22:234–239 especially those with less than optimal blood pressure, are at high risk for heart failure. The prevalence and diagnostic value of heart failure symptoms in elderly primary care patients with hypertension is unknown. Method Between June 2010 and January 2013, 591 primary care hypertension patients aged between 60 and 85 years were included, without known heart failure and not treated by a cardiologist.

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