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Ventricular arrhythmias in hypertension: in which patients do they occur?
J Mayet1, M Shahi, N R Poulter
1Department of Cardiology, St Mary's Hospital Medical School, London, UK.
Insights
Long-term antihypertensive therapy in patients with hypertension and left ventricular hypertrophy was associated with a higher prevalence of complex ventricular arrhythmias compared to untreated patients. This finding may explain excess sudden deaths in hypertensive individuals.
Area of Science:
- Cardiology
- Clinical Hypertension
- Electrophysiology
Background:
- Hypertension is linked to increased sudden cardiac death, particularly in patients with left ventricular hypertrophy (LVH).
- Ventricular arrhythmias are suspected contributors to this increased mortality.
- This study investigates factors influencing arrhythmias in hypertensive patients with LVH.
Purpose of the Study:
- To assess factors contributing to ventricular arrhythmias in hypertensive patients.
- To compare arrhythmia prevalence in treated versus untreated hypertensive patients with LVH.
- To explore the potential link between antihypertensive therapy and arrhythmia complexity.
Main Methods:
- 103 subjects were categorized into four groups: hypertensive with LVH, hypertensive without LVH, borderline/white-coat hypertension, and normotensive.
- Comprehensive assessments included echocardiography, ECG, exercise stress testing, and 24-h ambulatory BP and Holter monitoring.
- A subgroup of 17 treated hypertensive patients with LVH was compared to matched untreated patients.
Main Results:
- Untreated hypertensive patients, including those with LVH, showed a low prevalence of frequent or complex arrhythmias.
- A significantly higher prevalence of complex ventricular arrhythmias was observed in hypertensive patients with LVH receiving long-term antihypertensive therapy.
- Seven of 80 untreated patients had Lown score 2+, compared to eight of 17 treated patients.
Conclusions:
- Long-term antihypertensive therapy in hypertensive patients with LVH is associated with a high prevalence of complex ventricular arrhythmias.
- This contrasts with findings in untreated hypertensive patients, suggesting a potential consequence of treatment on the left ventricle.
- The increased complexity of arrhythmias in treated patients may be a significant factor in the excess sudden deaths observed in hypertensive populations.
Objective:
It has been suggested that the increased incidence of sudden death in hypertensive patients, particularly those with left ventricular hypertrophy, may be casually related to the increased number and complexity of ventricular arrhythmias that have been demonstrated in these patients. The objective of the present study was to assess some of the factors which might be responsible for these arrhythmias.
Subjects And Methods:
One hundred and three untreated subjects were divided into four groups on the basis of blood pressure and echocardiographic measurements: hypertensive patients with left ventricular hypertrophy (n = 38), hypertensive patients without left ventricular hypertrophy (n = 16), patients with borderline or white-coat hypertension (n = 26) and normotensive subjects (n = 23). Each subject underwent two-dimensional and Doppler echocardiography, 12-lead electrocardiogram examination, 12-lead electrocardiogram exercise stress testing, 24-h ambulatory blood pressure monitoring and 24-h Holter monitoring. A further 17 hypertensive patients with left ventricular hypertrophy who were on long-term antihypertensive therapy were also investigated in the same manner and compared with untreated hypertensive patients with left ventricular hypertrophy who were matched for age, sex and race.
Results:
Untreated hypertensive patients, even with left ventricular hypertrophy, had a low prevalence of frequent or complex arrhythmias (seven out of 80 patients with Lown score 2+). In contrast, hypertensive patients with left ventricular hypertrophy on long-term antihypertensive therapy had a significantly greater prevalence of complex arrhythmias than untreated patients with left ventricular hypertrophy (eight out of 17 treated patients compared with two out of 17 untreated patients with Lown score 2+).
Conclusions:
Hypertensive patients with left ventricular hypertrophy who had received long-term antihypertensive therapy were found to have a high prevalence of complex ventricular arrhythmias, which was in contrast to untreated hypertensive patients, even those with left ventricular hypertrophy. This may reflect the consequences on the left ventricle of long-term antihypertensive treatment. If complex ventricular arrhythmias are implicated in the excess of sudden deaths in hypertensive patients, this might be an important factor.