Ventricular Arrhythmias in Patients with Hypertensive Left Ventricular Hypertrophy

TLDR

In hypertensive patients, left ventricular hypertrophy on ECG is associated with a higher risk of sudden death beyond hypertension alone, yet the clinical significance of related arrhythmias remains uncertain. The study examined the frequency of complex ventricular arrhythmias using 48‑hour ambulatory ECG monitoring in 100 treated hypertensive patients (50 with LVH, 50 without) and 50.

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 ≥3 complexes at a rate ≤120 beats per minute, occurred in 14 (28 percent) of the 50 patients with an electro-cardiographic pattern of left ventricular hypertrophy, in 4 (8 percent) of the 50 patients without hypertrophy (P<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. (N Engl J Med 1987; 317:787–92.)