Antihypertensive treatment for the management of premature ventricular complexes. Pilot study

An acute increase in blood pressure (BP) may be associated with the appearance of premature ventricular complexes (PVC's) while an acute decrease in BP may reduce preexisting ones. Forty-two patients were studied in order to assess the critical BP value above which PVC's exist, the effect of chronic antihypertensive treatment on PVC's and the possibility to predict the antiarrhythmic effect of oral antihypertensive treatment by an acute test. Twenty-four subjects had over 10 min-1 PVC's at rest and received an intravenous sodium nitroprusside solution. Their systolic PB (SBP) was reduced from 156.3 +/- 34.1 (means +/- SD) mmHg to 96.2 +/- 21.3 mmHg and the PVC's from 29.6 +/- 10.7 min-1 to 4.5 +/- 9.0 min-1. The PVC's were completely eliminated in 16 cases and were fewer in the remaining 8 cases. When the SBP returned to its pre-test level, the PVC incidence also returned to its initial value. In 15 other cases with a SBP 134.9 +/- 18.3 mmHg and no PVC's at rest a metaraminol infusion was started. In 13 cases PVC's appeared at a SBP over 169.0 +/- 27.0 mmHg. The critical SBP below which there were no PVC's ranged widely in the 2 groups from below 75 mmHg to over 210 mmHg. In 11 cases of the nitroprusside group, 3 cases of the metaraminol group and 3 more cases a 24-hour Holter monitoring was applied. Then oral antihypertensive treatment was given (to 16/17 cases) for one week (amiloride 5 mg + hydrochlorothiazide 50 mg, supplemented, if needed, by methyldopa or hydralazine) and the Holter monitoring was repeated. The casual SBP measured before each Holter monitoring was initially 150.6 +/- 26.3 mmHg and was reduced by 20.3 +/- 15.4 mmHg (p less than 0.001). The number of 24-hour PVC's was 8469 +/- 10,007 and was significantly (p less than 0.005) reduced by 6077 +/- 7863 in all patients. The critical over casual SBP ratio was significantly (p less than 0.002) related to the 24-hour PVC's. It is concluded that the critical SBP varies widely in different persons and its determination by an acute BP-changing test may help in predicting to what extent an oral antihypertensive treatment may reduce the number of PVC's.