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Ventricular arrhythmias in patients with hypertensive left ventricular hypertrophy
Insights
Hypertensive patients with left ventricular hypertrophy show more complex ventricular arrhythmias, increasing sudden death risk. This study monitored 100 treated hypertensives and 50 controls for arrhythmias.
Area of Science:
- Cardiology
- Electrophysiology
- Hypertension Research
Background:
- Left ventricular hypertrophy (LVH) in hypertensive patients is linked to increased sudden death risk.
- The frequency of complex ventricular arrhythmias in this population needs further investigation.
Purpose of the Study:
- To determine the occurrence of complex ventricular arrhythmias in treated hypertensive patients with and without electrocardiographic evidence of LVH.
- To compare arrhythmia frequency against normotensive controls.
Main Methods:
- 48-hour ambulatory electrocardiographic monitoring was used.
- 100 treated hypertensive patients (50 with LVH, 50 without) and 50 normotensive controls were studied.
- Groups were matched for age, sex, smoking habits, and blood pressure.
Main Results:
- Nonsustained ventricular tachycardia (NSVT) occurred in 28% of hypertensive patients with LVH vs. 8% without LVH (P<0.05) and 2% of controls.
- 16% of patients with LVH experienced NSVT longer than 5 complexes, compared to 0% in other groups.
- NSVT was associated with high left ventricular mass and ST-T abnormalities, not blood pressure or diuretic use.
Conclusions:
- Complex ventricular arrhythmias are common in hypertensive patients with LVH.
- These arrhythmias may contribute to the elevated sudden death risk observed in this patient group.
Abstract:
In patients with hypertension, a pattern of left ventricular hypertrophy on the electrocardiogram is associated with a risk of sudden death in excess of the risk attributable to hypertension alone. We therefore investigated the frequency of complex ventricular arrhythmias by means of 48-hour ambulatory electrocardiographic monitoring in 100 treated hypertensive patients, of whom 50 had electrocardiographic evidence of left ventricular hypertrophy and 50 did not, and in 50 normotensive controls. The groups were matched for age, sex, and smoking habits, and the two hypertensive groups were matched for blood-pressure levels before and after antihypertensive therapy. Nonsustained ventricular tachycardia, defined as greater than or equal to 3 complexes at a rate greater than or equal to 120 beats per minute, occurred in 14 (28 percent) of the 50 patients with an electrocardiographic pattern of left ventricular hypertrophy, in 4 (8 percent) of the 50 patients without hypertrophy (P less than 0.05), and in 1 (2 percent) of the control subjects. Eight of the 50 patients (16 percent) with hypertrophy had episodes of nonsustained ventricular tachycardia longer than 5 complexes, whereas no patients without hypertrophy and no controls had such episodes. The group with nonsustained ventricular tachycardia was characterized by a high left ventricular mass on echocardiography and a high prevalence of ST-T abnormalities on electrocardiography. Ventricular tachycardia was not closely related to blood-pressure levels, nor was it associated with diuretic therapy or hypokalemia. The clinical importance of these arrhythmias is uncertain. Nevertheless, our data suggest that complex ventricular arrhythmias occur commonly in hypertensive patients with left ventricular hypertrophy and may contribute to the higher incidence of sudden death in these patients.