In patients with hypertension, a pattern of left ventricular hypertrophy on the electrocardiogram is associated with a risk of sudden death in excess of the risk attributable to hypertension alone. We therefore investigated the frequency of complex ventricular arrhythmias by means of 48-hour ambulatory electrocardiographic monitoring in 100 treated hypertensive patients, of whom 50 had electrocardiographic evidence of left ventricular hypertrophy and 50 did not, and in 50 normotensive controls. The groups were matched for age, sex, and smoking habits, and the two hypertensive groups were matched for blood-pressure levels before and after antihypertensive therapy. Nonsustained ventricular tachycardia, defined as greater than or equal to 3 complexes at a rate greater than or equal to 120 beats per minute, occurred in 14 (28 percent) of the 50 patients with an electrocardiographic pattern of left ventricular hypertrophy, in 4 (8 percent) of the 50 patients without hypertrophy (P less than 0.05), and in 1 (2 percent) of the control subjects. Eight of the 50 patients (16 percent) with hypertrophy had episodes of nonsustained ventricular tachycardia longer than 5 complexes, whereas no patients without hypertrophy and no controls had such episodes. The group with nonsustained ventricular tachycardia was characterized by a high left ventricular mass on echocardiography and a high prevalence of ST-T abnormalities on electrocardiography. Ventricular tachycardia was not closely related to blood-pressure levels, nor was it associated with diuretic therapy or hypokalemia. The clinical importance of these arrhythmias is uncertain. Nevertheless, our data suggest that complex ventricular arrhythmias occur commonly in hypertensive patients with left ventricular hypertrophy and may contribute to the higher incidence of sudden death in these patients.
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122: 919-928
[Abstract][Full Text]
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[Full Text]
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(2001). T Wave Alternans and Ventricular Arrhythmias in Arterial Hypertension. Hypertension
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(2000). Hypertensive heart disease. A complex syndrome or a hypertensive 'cardiomyopathy'?. Eur Heart J
21: 1653-1665
Hamasaki, S., Al Suwaidi, J., Higano, S. T., Miyauchi, K., Holmes, D. R. Jr., Lerman, A.
(2000). Attenuated coronary flow reserve and vascular remodeling in patients with hypertension and left ventricular hypertrophy. J Am Coll Cardiol
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[Abstract][Full Text]
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[Abstract][Full Text]
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35: 569-582
[Abstract][Full Text]
Frohlich, E. D.
(1999). Risk Mechanisms in Hypertensive Heart Disease. Hypertension
34: 782-789
[Abstract][Full Text]
Crawford, M. H., Bernstein, S. J., Deedwania, P. C., DiMarco, J. P., Ferrick, K. J., Garson, A. Jr, Green, L. A., Greene, H. L., Silka, M. J., Stone, P. H., Tracy, C. M., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Gardner, T. J., Garson, A. Jr, Gregoratos, G., Russell, R. O., Ryan, T. J., Smith, S. C. Jr
(1999). ACC/AHA guidelines for ambulatory electrocardiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography) developed in collaboration with the North American Society for Pacing and Electrophysiology. J Am Coll Cardiol
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(1999). Trends in the Prevalence of Hypertension, Antihypertensive Therapy, and Left Ventricular Hypertrophy from 1950 to 1989. NEJM
340: 1221-1227
[Abstract][Full Text]
Haider, A. W., Larson, M. G., Benjamin, E. J., Levy, D.
(1998). Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. J Am Coll Cardiol
32: 1454-1459
[Abstract][Full Text]
Nakamura, K., Fushimi, K., Kouchi, H., Mihara, K., Miyazaki, M., Ohe, T., Namba, M.
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[Abstract][Full Text]
Onwuanyi, A., Hodges, D., Avancha, A., Weiss, L., Rabinowitz, D., Shea, S., Francis, C. K.
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[Abstract][Full Text]
Fariello, R., Crippa, M., Damiani, G., Notaristefano, I., Costa, R., Boni, E., Corda, L., Chiari, E., Zaninelli, A.
(1998). Ventricular Arrhythmias in Normotensive Subjects and in Mild Hypertensive Patients. ANGIOLOGY
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[Abstract]
Shipsey, S. J., Bryant, S. M., Hart, G.
(1997). Effects of Hypertrophy on Regional Action Potential Characteristics in the Rat Left Ventricle : A Cellular Basis for T-Wave Inversion?. Circulation
96: 2061-2068
[Abstract][Full Text]
Manolis, A. J., Beldekos, D., Hatzissavas, J., Foussas, S., Cokkinos, D., Bresnahan, M., Gavras, I., Gavras, H.
(1997). Hemodynamic and Humoral Correlates in Essential Hypertension : Relationship Between Patterns of LVH and Myocardial Ischemia. Hypertension
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[Abstract][Full Text]
Cerbai, E., Barbieri, M., Mugelli, A.
(1996). Occurrence and Properties of the Hyperpolarization-Activated Current If in Ventricular Myocytes From Normotensive and Hypertensive Rats During Aging. Circulation
94: 1674-1681
[Abstract][Full Text]
Schillaci, G., Verdecchia, P., Borgioni, C., Ciucci, A., Zampi, I., Battistelli, M., Gattobigio, R., Sacchi, N., Porcellati, C.
(1996). Association Between Persistent Pressure Overload and Ventricular Arrhythmias in Essential Hypertension. Hypertension
28: 284-289
[Abstract][Full Text]
Perkiomaki, J. S., Ikaheimo, M. J., Pikkujamsa, S. M., Rantala, A., Lilja, M., Kesaniemi, Y. A., Huikuri, H. V.
(1996). Dispersion of the QT Interval and Autonomic Modulation of Heart Rate in Hypertensive Men With and Without Left Ventricular Hypertrophy. Hypertension
28: 16-21
[Abstract][Full Text]
De Lima, J. J. G., Lopes, H. F., Grupi, C. J., Abensur, H., Giorgi, M. C. P., Krieger, E. M., Pileggi, F.
(1995). Blood Pressure Influences the Occurrence of Complex Ventricular Arrhythmia in Hemodialysis Patients. Hypertension
26: 1200-1203
[Abstract][Full Text]
Kokkinos, P. F., Narayan, P., Colleran, J. A., Pittaras, A., Notargiacomo, A., Reda, D., Papademetriou, V.
(1995). Effects of Regular Exercise on Blood Pressure and Left Ventricular Hypertrophy in African-American Men with Severe Hypertension. NEJM
333: 1462-1467
[Abstract][Full Text]
Chambers, J.
(1995). Left ventricular hypertrophy. BMJ
311: 273-274
[Full Text]
Misier, A. R. R., Opthof, T., van Hemel, N. M., Vermeulen, J. T., de Bakker, J. M.T., Defauw, J. J.A.M., van Capelle, F. J.L., Janse, M. J.
(1995). Dispersion of `Refractoriness' in Noninfarcted Myocardium of Patients With Ventricular Tachycardia or Ventricular Fibrillation After Myocardial Infarction. Circulation
91: 2566-2572
[Abstract][Full Text]
Chen, C.-H., Ting, C.-T., Lin, S.-J., Hsu, T.-L., Yin, F. C. P., Siu, C. O., Chou, P., Wang, S.-P., Chang, M.-S.
(1995). Different Effects of Fosinopril and Atenolol on Wave Reflections in Hypertensive Patients. Hypertension
25: 1034-1041
[Abstract][Full Text]
Diez, J., Laviades, C., Mayor, G., Gil, M. J., Monreal, I.
(1995). Increased Serum Concentrations of Procollagen Peptides in Essential Hypertension : Relation to Cardiac Alterations. Circulation
91: 1450-1456
[Abstract][Full Text]
Rials, S. J., Wu, Y., Ford, N., Pauletto, F. J., Abramson, S. V., Rubin, A. M., Marinchak, R. A., Kowey, P. R.
(1995). Effect of Left Ventricular Hypertrophy and Its Regression on Ventricular Electrophysiology and Vulnerability to Inducible Arrhythmia in the Feline Heart. Circulation
91: 426-430
[Abstract][Full Text]
Komsuoglu, B., Duman, E., $ener Komsuoglu, S., Gorcin, B.
(1993). Prevalence of Ventricular Premature Complexes in Healthy and Untreated Hypertensive Elderly People. ANGIOLOGY
44: 447-453
[Abstract]
Grossman, E., Shemesh, J., Shamiss, A., Thaler, M., Carroll, J., Rosenthal, T.
(1992). Left Ventricular Mass in Diabetes-Hypertension. Arch Intern Med
152: 1001-1004
[Abstract]
O'Kelly, B. F., Massie, B. M., Tubau, J. F., Szlachcic, J.
(1989). Coronary Morbidity and Mortality, Pre-existing Silent Coronary Artery Disease, and Mild Hypertension. ANN INTERN MED
110: 1017-1026
[Abstract]
Applegate, W. B.
(1989). Hypertension in Elderly Patients. ANN INTERN MED
110: 901-915
[Abstract]
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