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Ventricular arrhythmias and left ventricular hypertrophy in essential hypertension
Insights
A more selective hypertension diagnosis using 24-h ambulatory blood pressure monitoring identifies patients with left ventricular hypertrophy and diastolic dysfunction, significantly correlating with ventricular arrhythmias. This aids in preventing cardiovascular events.
Area of Science:
- Cardiology
- Hypertension Research
- Electrophysiology
Background:
- Essential hypertension and left ventricular hypertrophy increase mortality risk, particularly with ventricular arrhythmias.
- Previous hypertension studies used a low-threshold diastolic blood pressure criterion (> 95 mmHg).
- This study employed a more selective criterion for hypertension diagnosis using 24-h ambulatory blood pressure monitoring (ABPM).
Purpose of the Study:
- To evaluate the incidence of ventricular arrhythmia in hypertensive patients not on medication.
- To assess the correlation between hypertension, left ventricular hypertrophy, diastolic dysfunction, and ventricular arrhythmias.
- To identify patients at higher risk for cardiovascular events through precise diagnosis.
Main Methods:
- Screened 128 hypertensive patients based on WHO guidelines for 24-h ABPM.
- Included 85 patients with a 24-h mean blood pressure > 135/85 mmHg.
- Conducted M-mode, B-mode echocardiography, PW Doppler, and 24-h ECG Holter recordings.
Main Results:
- Left ventricular hypertrophy (LVH) was present in 70.6% of patients; diastolic dysfunction in 42.4%.
- Ventricular arrhythmias (Grades I-V) were detected in 82.4% of patients.
- Significant correlations were found between LVH and arrhythmia score (r=0.552), diastolic dysfunction and arrhythmia score (r=0.495), and both with arrhythmia score (r=0.586).
Conclusions:
- A selective hypertension diagnosis identifies a strong correlation between LVH, diastolic dysfunction, and ventricular arrhythmias.
- These findings highlight a more severe disease stage in selected hypertensive patients.
- Early detection of ventricular arrhythmias in these patients is crucial for primary prevention of major cardiovascular events.
Background:
Patients with essential hypertension and/or left ventricular hypertrophy and ventricular arrhythmias suffer from an increased mortality rate. In all previous studies on hypertension, the criterion for inclusion was diastolic blood pressure > 95 mmHg. This is a low selective threshold. Our study attempted to evaluate the incidence of ventricular arrhythmia in hypertensive patients not receiving pharmacological treatment and diagnosed by 24-h ambulatory blood pressure monitoring (ABPM), therefore using a more selective criterion than WHO guidelines.
Methods:
Hundred-twenty-height consecutive patients with hypertension diagnosed on the basis of WHO guidelines were screened for 24-h ambulatory blood pressure measurement. Eighty-five (66.4%) presented a 24-h mean blood pressure > 135/85 mmHg. All 85 patients were screened for M-mode, B-mode echocardiography, PW Doppler and 24-h ECG Holter recordings.
Results:
Sixty patients (70.6%) were affected by left ventricular hypertrophy and 25 were free (29.4%). Thirty-six patients (42.4%) had left ventricular diastolic dysfunction, 49 were free (57.6%). According to Lown and Wolf's classification of ventricular arrhythmia, 20 patients (23.5%) presented Grade I arrhythmia, 5 (5.9%) presented Grade II, 4 (4.7%) Grade III, 9 (10.6%) Grade IVA, 20 (23.5%) Grade IVB, 12 (14.1%) Grade V and 15 patients (17.6%) were free from premature ventricular complexes, namely Grade 0 arrhythmia. Left ventricular hypertrophy was found to correlate significantly with the arrhythmia score, r = 0.552 for p < 0.0001. Moreover, left ventricular diastolic dysfunction correlated significantly with the arrhythmia score, r = 0.495 for p < 0.0001. There was also a good correlation between left ventricular hypertrophy and left ventricular diastolic dysfunction, r = 0.616 for p < 0.0001. Among patients affected by left ventricular diastolic dysfunction and left ventricular hypertrophy, the correlation with the arrhythmia score was even closer, r = 0.586 for p < 0.0007.
Conclusions:
We conclude that by using a more selective criterion for the diagnosis of hypertension, we can identify patients with a highly significant statistical correlation between left ventricular hypertrophy and ventricular arrhythmia score, and also between diastolic dysfunction and the ventricular arrhythmia score, due to a more severe stage of disease. It is useful to detect those patients affected by ventricular arrhythmias for the primary prevention of major cardiovascular events.