R - Wave Voltage Changes in Relation to Arterial Pressure in Hypertensive Patients

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HIGH voltage of R waves in left precordial leads of the electrocardiogram has been proposed as a sign of left ventricular hypertrophy.1,2 A high incidence of abnormally large R waves in V5 has been reported in hypertensive patients with high diastolic arterial pressure.3 A rise in blood pressure following infusion of l-norepinephrine in normotensive subjects,4 and ligation of the aorta in animals,5 has resulted in an increase in the amplitude of the R waves. Considerable reduction in the voltage of R waves has been observed following satisfactory treatment of hypertension with methonium compounds6 and other antihypertensive agents.7 These observations suggest that elevated arterial pressure may be an important factor in influencing the amplitude of R waves, but this relationship has not been adequately investigated.

The present study determines the possible effects that the lowering of arterial pressure exerts on the amplitude of R waves in left precordial leads of hypertensive patients whose electrocardiograms show evidence that meets the criteria for left ventricular hypertrophy as defined by Sokolow and Lyon.1

Methods and Material

Twenty hypertensive patients whose electrocardiograms showed increased voltages of R and S waves in leads V5 and V1, respectively, were studied at the Cleveland Clinic Hospital. All the patients had a mild to moderately severe hypertension that was benign in 13 patients, malignant in 1 patient, and associated with renal arterial lesions in 6 patients. Evidence of mild cardiac enlargement with some prominence of the left ventricle was present in the roentgenograms of 9 patients, whereas in those . . .



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