Effects of drug therapy on cardiac arrhythmias and ischemia in hypertensives with LVH

Left ventricular hypertrophy (LVH) in hypertensive subjects is associated w ith an increased prevalence of ventricular arrhythmias. To evaluate the eff ect of antihypertensive treatment on cardiac arrhythmias (CA) and transient episodes of myocardial ischemia (TEMI), we studied 46 hypertensive patient s with LVH, divided into four groups randomly treated with enalapril, hydro chlorothiazide (HCTZ), atenolol, or verapamil (SR-V) for 6 months. Office b lood pressure and office heart rate values were recorded, in basal conditio ns, after 1 and 6 months of treatment, and all patients underwent echocardi ography, electrocardiographic Holter monitoring, and stress testing. All dr ugs significantly lowered blood pressure, whereas left ventricular mass ind ex was reduced by atenolol, enalapril, and SR-V, but not by HCTZ. Treatment induced a significant reduction in the number of patients with supraventri cular arrhythmias (35 v 15, P < .034, and 28 v 8, excluding patients treate d with HCTZ, P < .008). The number of patients with ventricular arrhythmias was also reduced (32 v 16 considering all groups, P < .08, and 24 v 9, exc luding patients treated with HCTZ, P < .04). The number of TEMI during Holt er monitoring significantly decreased from 47 to 23 (P = .043) in all patie nts, and from 39 to 14 (P = .013) excluding patients treated with HCTZ. In all groups, irrespective of treatment, a reduction of blood pressure, heart rate, and systolic blood pressure/heart rate product measured by exercise stress test was observed. The present study shows that in hypertensive pati ents with LVH, antihypertensive treatment with atenolol, enalapril and SR-V reduces LVH and decreases the prevalence of CA and TEMI. Treatment with HC TZ during the g-month study did not alter LVH and did not appear to reduce CA and TEMI. (C) 2001 American Journal of Hypertension, Ltd.