PROGNOSTIC VALUE OF VENTRICULAR ARRHYTHMIAS IN HYPERTENSIVE PATIENTS

Objective: Hypertensive left ventricular hypertrophy (LVH) is associat ed with increased risk of arrhythmias and mortality. However, no clini cal study demonstrated a significant relation between ventricular arrh ythmias and mortality in systemic hypertension. Design and methods : T o evaluate the prognostic value of arrhythmogenic markers in systemic hypertension, we included between 1987 and 1993, 214 hypertensive pati ents. 59.1 +/- 12.8 years old, without symptomatic coronary disease, m yocardial infarction, systolic dysfunction, electrolyte disturbances o r antiarrhythmic therapy. At inclusion, an ECG, a 24 h Holter ECG (204 patients) with Lown classification of ventricular arrhythmias, an ech ocardiography (reliable in 187 patients) with left ventricular mass in dex and ejection fraction calculation, a SAECG (125 patients, enrolled after 1988) with ventricular late potentials (LP) were recorded. QT i nterval dispersion (QTd) was calculated on 12 leads standard 806 and L VH was appreciated. Results: At baseline echocardiographic LVH was rec orded in 63 patients (33.7%) with normal election fraction (75 +/- 7.4 %). Non-sustained ventricular tachycardia (Lown IVb) was found in 33 p ts (16.2%) and LP in 27 patients (21.6%). After a mean follow up of 42 .4 +/- 26.8 months, all-cause mortality was 11.2% (24 patients); 17 pa tients died of cardiac causes (7.9%); of these 9 patients (4.2%) died suddenly. In univariate analysis, age, strain pattern of LVH, advanced Lown classes and abnormal QT dispersion (> 80 ms) were significantly related to global, cardiac and sudden death (p less than or equal to 0 .01). Left ventricular mass index was closely related to cardiac morta lity (p = 0.002). LP failed to predict mortality. In multivariate anal ysis, only Lown class IVb was an independent predictor of global and c ardiac mortality, increasing the risk of global death 2.6 fold [1.2-6. 0] (CI 95%) and the risk of cardiac death 3.5 fold [1.2-9.7] (CI 95%). Conclusions: In hypertensive patients the presence of non-sustained v entricular tachycardia on 24 h Holter has a prognostic value.