The neglected role of the electrocardiogram in the diagnostic work-up of hypertensive patients: a study in clinical practice

The electrocardiogram (ECG) is listed among the routine diagnostic examinations for hypertensive patients according to international guidelines. Objective: The aim of this survey was to investigate whether an ECG is routinely prescribed before an echocardiographic examination by general practitioners for the evaluation of subclinical cardiac damage in uncomplicated hypertensive patients in a suburban area of Italy. Methods: A total of 60 consecutive hypertensive patients (45 % men, mean age 60 ± 14 years) referred to a single out-patient cardiology service by their general practitioners for the assessment of cardiac organ damage by echocardiography were enrolled in the study. Patients' demographic data and medical history were collected at the echocardiographic laboratory on a questionnaire administered by the attending physician. Results: Less than 40 % of the study sample had undergone an ECG during the 12-month period preceding the echocardiographic examination. Notably, only 60 % of newly diagnosed hypertensive patents had an ECG done after the discovery of their hypertensive status. Conclusions: These findings show that an ECG is not routinely prescribed as a first-line examination in the assessment of cardiac organ damage related to hypertension by a large fraction of general practitioners in current clinical practice in a northern area of Italy. This contrasts with available evidence that the combined assessment of left ventricular hypertrophy by ECG and echocardiogram provides the best evaluation of cardiac damage and stratification of cardiovascular risk in hypertension.