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[Silent ischemia and ventricular arrhythmias in essential hypertension]
1Cardiologia Ambulatoriale, ASL BR 1, Brindisi, Italy. pasqualepalmiero@yahoo.it
Insights
A more selective criterion for diagnosing hypertension identifies patients with more severe disease and higher rates of ventricular arrhythmias and silent ischemia. This allows for targeted primary prevention of coronary events in at-risk individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Electrophysiology
Context:
- Hypertension is a significant risk factor for coronary artery disease and increased mortality, particularly when associated with silent ischemia or ventricular arrhythmias.
- Traditional diagnostic criteria for hypertension (diastolic blood pressure >95 mmHg) are not highly selective.
- Silent ischemia affects 4-5% of individuals over fifty, with higher prevalence in hypertensive patients.
Purpose:
- To evaluate the rate of ventricular arrhythmias in hypertensive patients without pharmacological therapy using a more selective diagnostic criterion based on 24-hour ambulatory blood pressure monitoring (ABPM).
- To assess the correlation between left ventricular hypertrophy, ventricular arrhythmias, and silent ischemia (ST depression) in this patient cohort.
Summary:
- Eighty-five hypertensive patients meeting a selective ABPM criterion (>135/85 mmHg) were assessed via echocardiography and Holter monitoring.
- Left ventricular hypertrophy was present in 70.6% of patients. Ventricular arrhythmias (Lown grades III-V) and silent ischemia (ST depression) were detected in significant proportions.
- Left ventricular hypertrophy strongly correlated with arrhythmia severity and silent ischemia.
Impact:
- Employing a more selective diagnostic criterion for hypertension enables the identification of patients with more severe disease.
- This approach facilitates early detection and targeted primary prevention strategies for coronary events in high-risk hypertensive individuals.
Background:
Silent ischemia episodes rate is 4-5% among over fifty aged people. Patients affected by hypertension have higher coronary artery disease rate than people with normal blood pressure. An increased mortality is present among patients affected by essential hypertension, especially if affected by silent ischemia and /or ventricular arrhythmias. In all previous study about hypertension, the inclusion criterion was a diastolic blood pressure >95 mmHg, that is a low selective one. The aim of study is to evaluate ventricular arrhythmias rate, in hypertensive patients, without pharmacological therapy, and diagnosed by 24 hours ambulatory blood pressure monitoring (ABPM), so using a more selective criterion than WHO rules.
Methods:
128 consecutive patients with hypertension diagnosis by WHO rules, were screened for 24 hours ambulatory blood pressure measurement (ABPM); 85 of them (66.4%) had 24 hours mean blood pressure >135/85 mmHg. These 85 patients were screened for M-mode, B-mode echocardiography and 24 hours electrocardiogram monitoring by Holter.
Results:
Sixty patients (70.6%) were affected by left ventricular hypertrophy, 25 were free (29.4%) According to the Lown and Wolf classification for ventricular arrhythmias 20 patients (23.5%) had a Grade I arrhythmia, 5 (5.9%) had a Grade II, 4 (4.7%) had a Grade III, 9 (10.6%) had a Grade IV A, 20 (23.5%) had a Grade IV B, 12 (14.2%) had a Grade V and 15 patients (17.6%) were free from premature ventricular complexes. 40 patients (47%) had one or more ST depression episodes longer than 60 . The range of episodes number is 1-22, mean 6.8; their duration range is 1-16 minutes, mean 7.6 minutes. In our study, left ventricular hypertrophy correlate significantly with arrhythmia Lown score, r=0.552 for p<0.0001 and also with silent ischemia as ST depression r=0.51, p<0.004. The correlation, between arrhythmia score and ST depression, r=0.042, p<0.021 is not highly significant.
Conclusions:
The conclusion is drawn that using a more selective criterion for the diagnosis of hypertension, it is possible to identify patients affected by a more severe stage of disease, and detect them for primary prevention of coronary events.