Prevalence and prognostic significance of electrocardiographic left ventricular hypertrophy in patients presenting with hypertensive intracerebral haemorrhage

This study examines the prevalence of undiagnosed hypertension and the prognostic significance of electrocardiographic left ventricular hypertrophy (LVH) in patients with hypertensive spontaneous intracerebral haemorrhage (SICH). A retrospective cohort analysis was conducted on 671 patients admitted to a tertiary centre between 2017 and 2020, categorised based on their hypertension status and the presence of electrographic LVH. The prevalence of undiagnosed hypertension was 32.5 %, demonstrating the substantial burden of unrecognised hypertension even in a first-world healthcare setting. Electrographic LVH was associated with higher systolic blood pressure on admission (200 mmHg) but was not significantly linked to mortality or functional outcomes at discharge or three months. However, patients with LVH tended to have higher modified Rankin Scale (MRS) scores, suggesting a potential association with greater disability, though this did not reach statistical significance. Additionally, patients with newly diagnosed hypertension with no electrographic LVH changes exhibited a higher prevalence of lobar haemorrhages (27.8 %), suggesting a possible relationship between episodic hypertension and lobar bleeds. While electrographic LVH serves as an important marker of chronic hypertensive burden, its prognostic value in predicting SICH outcomes appears to be limited. These findings reinforce the need for early detection and effective management of hypertension to reduce the risk of cerebrovascular events and support the development of targeted therapeutic strategies for patients with varying hypertensive profiles.