CARDIAC ARRHYTHMIAS AND LEFT VENTRICULAR HYPERTROPHY IN SYSTEMIC HYPERTENSION

Riffat Sultana, Nuzhat Sultana, Abdul Rashid, Syed Zahid Rasheed, Mansoor Ahmed, Muhammad Ishaq, Abdus Samad

Abstract


Background: Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of
arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and
LVH in systemic hypertension. Methods: In all subjects blood pressure was measured,
electrocardiography and echocardiography was done. Holter monitoring and exercise test perform
in 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%) were
dyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Duration of
hypertension (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±30
gm/m2 in male while 103±22 gm/m2 in female patients. Palpitation was seen in 126 (25%) male and
299 (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. Ventricular
tachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoring
showed 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 and
119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) with
CAD 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 between
hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and
function, 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 disease

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References


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.


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