What is the role of silent coronary artery disease and left ventricular hypertrophy in the genesis of ventricular arrhythmias in men with essential hypertension?

Abstract

Ventricular arrhythmias are not uncommon in patients with hypertension, are often attributed to left ventricular hypertrophy and are thought to be associated with an increased risk of sudden death. However, underlying silent coronary artery disease, another potential cause of ventricular arrhythmias, is often present in the same patient group. Therefore, the prevalence of ventricular arrhythmias was prospectively examined in 183 consecutive asymptomatic men with hypertension with neither clinical nor electrocardiographic (ECG) evidence of coronary artery disease in whom technically adequate echocardiograms could be obtained. After previous therapy had been withdrawn for ≥4 days, each patient underwent exercise or dipyridamole thallium-201 scintigraphy, 48-h Holter ambulatory ECG monitoring and echocardiography for measurement of the left ventricular mass index. Forty patients (22%) had frequent ventricular ectopic activity, defined on the basis of >10 premature ventricular complexes/h (38 patients) or ventricular tachycardia (11 patients), or both. A higher proportion of patients with than without a reversible thallium-201 defect had frequent premature ventricular complexes (33% vs. 18%, p < 0.02) or ventricular tachycardia (14% vs. 4%, p < 0.02). Similarly, more patients with than without left ventricular hypertrophy (defined as left ventricular mass index ≥134 g/m2) had frequent premature ventricular complexes (29% vs. 15%. p < 0.05) and ventricular tachycardia (12% vs. 2%, p < 0.01). By stepwise logistic regression analysis, both findings were independent predictors of ventricular arrhythmia, which was present in 53% of patients with both abnormalities, but in only 12% of those with neither abnormality. In addition, ventricular arrhythmias were more common in patients who had than in those who had not previously been treated with a diuretic drug, even though there were no differences between patients in serum electrolytes at the time of study. These results indicate that silent myocardial ischemia and left ventricular hypertrophy are independently associated with ventricular arrhythmias in patients who are asymptomatic and have mild to moderate hypertension. © 1992.