Predictors of sudden cardiac death in never previously treated patients with essential hypertension: long-term follow-up

Abstract

Increased QT dispersion has been associated with ventricular arrhythmia and sudden death in a variety of cardiac disorders. Left ventricular hypertrophy (LVH) has also been associated with increased incidence of sudden cardiac death in patients with essential hypertension. Furthermore, patients with essential hypertension, particularly those with LVH, are more likely to develop ventricular arrhythmias than are the normal population. The relationship between LVH, QT dispersion, complex ventricular arrhythmia and sudden cardiac death in previously untreated patients over long-term follow-up in hypertension has not been reported before and is the purpose of this study. Fifty-nine adult subjects with essential hypertension, who had never been previously on antihypertensive treatment were followed up for a total of 119.2 ؎ 26.2 months. QTc (corrected QT), blood pressure, electrocardiograms, and 24-h Holter ECG recordings were performed in all patients at the time of entry to the study. Ventricular arrhythmias were classi-

Usefulness of QT-interval parameters for cardiovascular risk stratification in type 2 diabetic patients with arterial hypertension

“…The main finding of this prospective study with up to 7 years of follow-up is that prolonged QTd added prognostic information for cardiovascular morbidity and mortality beyond that obtained by other con- [10][11][12] have addressed this question. The first 10 involved 214 hypertensives followed up for a mean of 42 months and observed 24 all-cause deaths and 17 cardiac deaths.…”

“…The present investigation had a greater number of patients and of fatal end points than these previous studies, also addressed nonfatal major cardiovascular events as a primary end point and was the first to evaluate the effect of the combination of QT parameters and Echo-LVH on survival . Also, both previous studies 10,11 included the prognostic information derived from 24-h Holter monitoring, which was unavailable in the present one. Otherwise, we can speculate that possibly the presence of frequent premature ventricular contractions on baseline ECGs, demonstrated here to be the most important predictor of cardiovascular and cardiac mortalities, could provide prognostic information equivalent to the presence of high-grade ventricular arrhythmias on Holter monitoring.…”

“…Although increased QTd was associated with total and cardiac mortalities in univariate analysis; only age, increased LVM and the presence of nonsustained ventricular tachycardia on 24-h Holter monitoring were independent predictors of death in multivariate analysis. The second study 11 evaluated 59 previously untreated hypertensive patients followed up for a mean of 119 months and observed only 12 deaths, six of them sudden deaths. As in the previous report, LVH and complex ventricular arrhythmias on Holter were associated with cardiac mortality.…”

“…7 In patients with arterial hypertension, QT-interval parameters have mainly been associated with left ventricular mass (LVM). 8,9 Only three studies [10][11][12] evaluated their usefulness as cardiovascular mortality risk indicators. We have previously reported 5 that two QT parameters, maximum heart ratecorrected QT-interval duration (QTcmax) and QTinterval dispersion (QTd) were prognostic factors for cardiovascular morbidity and mortality in the entire cohort of type 2 diabetic patients that included hypertensive and normotensive subjects, and also that QTcmax, but not QTd, was a specific predictor of future incident strokes 13 and of total mortality.…”

Perspective on Selected Issues in Cardiovascular Disease Research With a Focus on Black Americans

“…8 LVH in the presence of hypertension is associated with an increased risk of sudden cardiac death, probably due in part to complex ventricular arrhythmias, factors related to myocardial oxygen supply/ demand, and subendocardial fibrosis. 7,9 In one study that included only black males, among those men with hypertensive LVH, asymptomatic non-sustained ventricular tachycardia independently predicted subsequent cardiovascular events. 10 These findings warrant further investigation, particularly because black Americans have a higher prevalence of out of hospital sudden cardiac death than other race/ethnic groups, an outcome that likely reflects both physiological and access-to-care issues.…”