Risk of ventricular arrhythmias in hypertensive men with left ventricular hypertrophy

The echocardiographic predictors of ventricular arrhythmias are reported for the Hypertension Arrhythmia Reduction Trial. Men with mild hyper-tension were withdrawn from their diuretic therapy and repleted with 40 mEq/day of oral potassium and 20 mEq/day of oral magnesium for 1 month. M-mode echocardiography and 24-hour continuous ambulatory electrocardiography were performed on 123 men, mean age 62 years. Forty-eight men (39%) had echocardiographic evidence of left ventricular (LV) hypertrophy defined as an LV mass index > 134 g/m² and this finding was not related to the presence of LV hypertrophy on electrocardiogram or to age. Men who had echocardiographic LV hypertrophy were more likely than men without echocardiographic LV hypertrophy to have ≥30 ventricular premature complexes (VPCs)/hr (odds ratio = 2.7; 95% confidence interval = 0.9, 8.0), multi-form extrasystoles (odds ratio = 1.7; confidence interval = 0.8, 3.7), episodes of ventricular tachycardia (odds ratio = 2.3; confidence interval = 0.7, 7.1) and the combination of frequent (≥30 VPCs/hr) or complex (ventricular couplets, multi-form extrasystoles or episodes of ventricular tachycardia) ventricular arrhythmia (odds ratio = 1.7; confidence interval = 0.8, 3.5). Similar associations between echocardiographic LV hypertrophy and ventricular arrhythmias were observed on 24-hour tracings obtained on entry to the study (before electrolyte repletion) in the 96 men who were taking diuretics at this time. The combination of a frequent or complex arrhythmia was also more common in men aged 60 to 70 compared to men aged 35 to 59 (odds ratio = 3.4; confidence interval = 1.4, 8.2). These findings suggest that ventricular arrhythmias occur more commonly in older hyper-tensive men and in hypertensive men with echocardiographic LV hypertrophy.