CARDIAC ARRHYTHMIAS AND LEFT VENTRICULAR HYPERTROPHY IN SYSTEMIC HYPERTENSION
Abstract
Background: Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk ofarrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias andLVH in systemic hypertension. Methods: In all subjects blood pressure was measured,electrocardiography and echocardiography was done. Holter monitoring and exercise test performin certain cases. There were 500 hypertensive patients, 156 (31.2%) men and 344 (69%) women>30 years of age in the study. Among them 177 (35.4%) were diabetic, 224 (45%) weredyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Duration ofhypertension (HTN) was ≥2 years). Mean systolic BP (SBP) was 180±20 mm Hg and diastolic BP(DBP) was 95±12 in male and female patients. Left ventricular mass index (LVMI) was 119.2±30gm/m2 in male while 103±22 gm/m2 in female patients. Palpitation was seen in 126 (25%) male and299 (59.8%) female patients. Atrial fibrillation was noted in 108 (21.6%) male and 125 (25%)female patients, 30 (6%) male and 82 (16.4%) female patients had atrial flutter. Ventriculartachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoringshowed significant premature ventricular contractions (PVC’S) in 109 (21.8%) male and 128(25.69%) female patients while Holter showed atrial arrhythmias (APC’S) in 89 (17.8%) males and119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) withCAD male and 225 (45%) without CAD while 47 (9.4%) females presented with CAD and 109(21.8%) without CAD. Conclusion: A significant association has been demonstrated betweenhypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size andfunction, as well as LVH have been suggested as the underlying risk factors for supraventricular,ventricular arrhythmias and sudden death in hypertensives with LVH.Keywords: Hypertension, arrhythmias, left ventricular hypertrophy, coronary artery diseaseReferences
Aidietis A, Laucevicius A, Marinskis G. Hypertension and
cardiac arrhythmias. Curr Pharm Des 2007;13:2545–55.
Perings C, Hennersdorf M, Vester EG, Strauer BE. Arrhythmia
risk in left ventricular hypertrophy. Z Kardiol 2000;89(Suppl
:36–43.
Yildirir A, Batur MK, Oto A. Hypertension and arrhythmia:
blood pressure control and beyond. Europace 2002;4(2):175–82.
Ozdemir A, Telli HH, Temizhan A, Altunkeser BB, Ozdemir K,
Alpaslan M, et al. Left ventricular hypertrophy increases the
frequency of ventricular arrhythmia in hypertensive patients.
Anadolu Kardiyol Derg 2002;2(4):293–9.
Saadeh AM, Jones JV. Predictors of sudden cardiac death in
never previously treated patients with essential hypertension:
long-term follow-up. J Hum Hypertens 2001;15:677–80.
Akdeniz B, Güneri S, Badak O, Aslan O, Tamci B. Arrhythmia
risk and noninvasive markers in hypertensive left ventricular
hypertrophy. Anadolu Kardiyol Derg 2002;2(2):121–9.
Wolk R. Arrhythmogenic mechanisms in left ventricular
hypertrophy. Europace 2000;2(3):216–23.
Dorobantu M, Galinier M, Bounhoure JP. Ventricular
arrhythmias and arterial hypertension. Ann Cardiol Angeiol
(Paris) 1996;45(5):291–5.
Ruilope LM, Schmieder RE. Left ventricular hypertrophy and
clinical outcomes in hypertensive patients. Am J Hypertension
;21:500-8.
Kunisek J, Zaputovic L, Butorac MZ, Kunisek L, Lukin-Eskinja
K, Karlavaris R, et al. The prevalence of supraventricular
arrhythmias with regard to the type and degree of left ventricular
hypertrophy in patients with hypertensive heart disease. Wien
Klin Wochenschr 2008;120(5–6):171–7.
Malerba M, Muiesan ML, Zulli R, Rizzoni D, Calebich S,
Agabiti-Rosei E. Ventricular arrhythmias and changes in blood
pressure and left ventricular mass induced by antihypertensive
treatment in hypertensive patients. J Hypertens 1991;9(Suppl
:S162–3.
Bayés-Genís A, Guindo J, Viñolas X, Tomás L, Elosua R, Duran
I, et al. Cardiac arrhythmias and left ventricular hypertrophy in
systemic hypertension and their influences on prognosis. Am J
Cardiol 1995;76(13):54D–59D.
Borhani NO. Left ventricular hypertrophy, arrhythmias and
sudden death in systemic hypertension. Am J Cardiol
;60(17):13I–18I.
J Ayub Med Coll Abbottabad 2010;22(4)
http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Riffat.pdf
Mayet J, Shahi M, Poulter NR, Sever PS, Thom SA, Foale RA.
Ventricular arrhythmias in hypertension: in which patients do
they occur? J Hypertens 1995;13:269–76.
Galinier M, Balanescu S, Fourcade J, Dorobantu M, Massabuau
P, Dongay B, et al. Prognostic value of ventricular arrhythmia in
hypertensive patients. Arch Mal Coeur Vaiss 1997;90:1049–53.
The AFFIRM Investigators. Baseline characteristics of patients
with atrial fibrillation: the AFFIRM study. Am Heart J
;143:991–1001.
Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE,
Rautaharju PM .Prevalence of atrial fibrillation in elderly subjects
(the Cardiovascular Health Study). Am J Cardiol 1994;74:236–41.
Fauchier L, Robin I, de Labriolle A, Poret P, Giraudeau C,
Cosnay P, Babuty D. Risk stratification in atrial and ventricular
arrhythmias. Ann Cardiol Angeiol (Paris) 2006;55:127–34.
Pedretti RF, Catalano O, Ballardini L, de Bono DP, Radice E,
Tramarin R. Prognosis in myocardial infarction survivors with left
ventricular dysfunction is predicted by electrocardiographic RR
interval but not QT dispersion. Int J Cardiol 1999;68(1):83–93.
Abid Amin Khan, Zaheer Alam, Sara Inayat.
Electrocardiographic correlation of left ventricular hypertrophy
(in cases of Hypertension) with Echocardiography. Pak Heart J
;36(1–4):17–9.
Palmiero P, Maiello M. Ventricular arrhythmias and left
ventricular hypertrophy in essential hypertension. Minerva
Cardioangiol 2000;48:427–34.
Palmiero P, Maiello M. Silent ischemia and ventricular
arrhythmias in essential hypertension. Minerva Cardioangiol
;49:239–44.
[No authors listed]. Correlation between 24-hour profile of blood
pressure and ventricular arrhythmias and their prognostic
significance in patients with arterial hypertension. Vojnosanit
Pregl 2008;65:353–8.
Saadeh AM, Jones JV. Predictors of sudden cardiac death in
never previously treated patients with essential hypertension:
long-term follow-up. J Hum Hypertens 2001;15:677–80.
Makkar KM, Sanoski CA, Spinler SA. Role of AngiotensinConverting Enzyme Inhibitors, Angiotensin II Receptor
Blockers, and Aldosterone Antagonists in the Prevention of
Atrial and Ventricular Arrhythmias. Pharmacotherapy
;29(1):31–48.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
