Electrocardiogram abnormality and associated factors among hypertensive patients and normotensive participants attending outpatient department at referral hospitals in Amhara Regional State, Northwest Ethiopia, 2024; Multi-centered institutional-based comparative cross-sectional study design.

Abstract

Introduction: Globally, the magnitude of non-communicable diseases is increasing at an alarming rate. Hypertension can result in abnormalities in the heart structure and the electrical activity of the cardiac system.Therefore, early detection of these electrocardiographic abnormalities plays a crucial role in enhancing risk assessment and aiding in the management of hypertension. To the best of our searching, there was no evidence in Ethiopia. Therefore, this study aimed to assess electrocardiogram abnormalities and associated factors among Hypertensive patients and normotensive participants attending outpatient departments at Referral Hospitals of Amhara Regional State, Northwest Ethiopia, 2024. Methods: A multicentered institutional-based comparative cross-sectional study was conducted from April 11 to May 20, 2024. Three referral hospitals in Amhara Regional State were selected using lottery method. Hypertensive patients were selected by systematic random sampling, and 205 age and sex-matched voluntary participants were selected from attendants of patients in the outpatient department. The interviewer administered a questionnaire, and a digital electrocardiograph were used for data collection. Data were entered into EpiData version 4.6 and exported to Stata version 20 for analysis. Chi-squire (x2) and independent T-test were used to compare outcome variables between the two groups. Variables with a P value <0.25 in the bivariable analysis were selected for multivariable binary logistic regression. The strength of association was determined by an adjusted odds ratio with a 95% confidence interval (CI). A P-value of 0.05 was considered for statistical significance. Results: Among the study participants, the prevalence of ECG abnormalities was 64.9% (95% CI: 58.0-71.2%) among hypertensive patients and 23.4% (95% CI: 18.1-29.8%) among the normotensive group. Factors associated with ECG abnormalities included being hypertensive(AOR=7.43; 95% CI: 4.30-12.84), being male (AOR=2.73; 95% CI: 1.60-4.69), age over 60 years (AOR=4.68; 95% CI: 2.31-9.49), moderate/frequent alcohol consumption (AOR=2.5; 95% CI: 1.50-4.36), former/current smoking (AOR=5.20; 95% CI: 1.69-16.04), inadequate physical activity(AOR = 3.18, 95% CI = 1.83-5.52), and viii overweight (AOR=3.7; 95% CI: 1.86-7.37). Additionally, hypertensive patients with a duration of hypertension exceeding five years (AOR=3.48; 95% CI: 1.47-8.26) were significantly associated with ECG abnormalities. Conclusion and Recommendations: The prevalence of ECG abnormality was 44.1% among all study participants. From this, the proportion of ECG abnormality was higher among the hypertensive patients than their counterparts. Being male, advanced age, frequent/ moderate alcohol drinker, inadequate physical activity, and over five years duration of hypertension significantly associated with ECG abnormality. So, implementing routine ECG screening for hypertensive patients as a measure to decrease the occurrence of ECG abnormalities and mitigate potential complications is necessary.