INCREASED PREVALENCE OF CARDIAC-ARRHYTHMIAS AND TRANSIENT EPISODES OFMYOCARDIAL-ISCHEMIA IN HYPERTENSIVES WITH LEFT-VENTRICULAR HYPERTROPHY BUT WITHOUT CLINICAL HISTORY OF CORONARY HEART-DISEASE

To evaluate the behavior of cardiac arrhythmias (CA) and transient epi sodes of myocardial ischemia (TEMI), in relation to the circadian patt ern of blood pressure in patients suffering from arterial hypertension , with or without echocardiographically ascertained left ventricular h ypertrophy (LVH), we studied 128 patients, 87 men (M) and 41 women (F) , aging from 21 to 76 years, subdivided into two groups: Group I, incl uding 66 patients with LVH (45 M and 21 F; mean age of 53.7 +/- 9.1 ye ars; Group II, including 62 patients without LVH (42 M and 20 F; mean age of 49.7 +/- 9.5 years). Office blood pressure (OBP) as well as nig httime ambulatory blood pressure (ABP) were higher in patients with LV H (P < .05 and P < .01). CA were present in a higher number of patient s of Group I (P < .001): premature supraventricular beats (PSVB) 22.7 v 4.8%, supraventricular couplets (SVC) 36.4 v 16.1%, supraventricular tachycardia runs (SVT runs) 27.3 v 12.9%, ventricular ectopic beats ( VEE) 25.6 v 8.0%, ventricular couplets (VC) 30.3 v 12.9%, ventricular tachycardia runs (VT runs) 12.1 v 3.2%. The absolute number of ectopic beats was also significantly higher in patients of Group I. Ventricul ar arrhythmias were significantly related to ASBP (r = 0.83, P < .01), to ADBP (r = 0.74, P < .01) and to heart rate (r = 0.87, P < .01) in patients of Group I. TEMI were more frequent in patients of Group I (7 3 v 41 episodes, 39.39% v 25.8% of patients, P < .01) and were related to ABP peaks. In fact, in both groups of patients all TEMI without he art rate increase and most TEMI with heart rate increase were register ed between 6:00 and midnight, hours in which ABP values were higher. W e conclude that hypertensives with LVH, but without clinical history o f coronary heart disease, have a higher prevalence of ventricular arrh ythmias and of transient episodes of myocardial ischemia in relation t o the circadian pattern of ABP. (C) 1997 American Journal of Hypertens ion, Ltd.