HDCN Article Review/Hyperlink

Schillaci G, Verdecchia P, Borgioni C, et al

Association between persistent pressure overload and ventricular arrhythmias in essential hypertension

Hypertens (Aug) 28:284-289 1996

Patients in whom blood pressure does not decrease at night (non-dippers) appear to be at increased risk of end-organ damage, including LVH and microalbuminuria. As hypertension puts patients at increased risk for sudden cardiac death, the present paper studies risk factors for complex ventricular arrhythmias in hypertensive patients as a function of both LVH and their Continuous ambulatory BP profile.

One hundred twenty six previously untreated hypetensives were studied. The absence of treatment eliminated the potential confounding effect of previous therapy with diuretics, which may induce hypokalemia and increase the risk of arrhythmia, or beta blockers, which may decrease this risk. All patients had continuous ambulatory BP recording and measurement of LV mass by M-mode echo. Coronary artery disease was excluded, but only when clinically suspected, by exercise testing and/or thallium scintigraphy.

During 24 hour ECG monitoring premature ventricular beats (PVBs) were detected in 71% of subjects. When the Lown class of arrhythmia was plotted against the degree of nocturnal BP reduction, a substantial inverse correlation was found. Dippers had an average of about 100 PVB/24 hours, versus about 600 PVB/24 hours were found in non- dippers. The number of PVBs was markedly increased in patients with LVH vs. those without. LVH and a non-dipping BP pattern are usually correlated, but in a multiple regression analysis, both LVH and non-dipping BP pattern appeared to independently increase the chances of PVBs and complex arrhythmias. (John T. Daugirdas, M.D., University of Illinois at Chicago)

The full text of this abstract is available from the AHA at:
this site .