Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

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

Journal of Human Hypertension volume 15, pages 677–680 (2001)Cite this article

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 classified using a modified Lown’s scoring system. During the follow-up period death occurred in 12 cases (20%) of which only six (10%) deaths were sudden. The findings of this study indicate that LVH and complex ventricular arrhythmias (Lown’s score ⩾3) are the only significant predictors of sudden death. Although patients who died suddenly had higher systolic and diastolic blood pressures and greater QTc dispersion compared to surviving patients, this difference was statistically not significant. Similarly, when those who died suddenly were compared to those non-cardiac deaths, LVH and complex ventricular arrhythmias were the only significant predictors of sudden death. In spite of increased QTc dispersion in hypertensive patients, this finding was not associated with increased risk of sudden death and only LVH and high grade ventricular arrhythmias identified hypertensive patients at risk of sudden cardiac death over a 10-year follow-up period.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Le Heuzy JY, Guize L Cardiac prognosis in hypertensivepatients: incidence of sudden death and ventricular arrhythmias Am J Med 1988 84 (Suppl 1B) 65–68

    Article  Google Scholar 

  2. McLenachan JM, Henderson E, Morris KJ, Dargie HJ Ventricular arrhythmias inpatients with hypertensive left ventricular hypertrophy N Engl J Med 1987 317 787–792

    Article  CAS  PubMed  Google Scholar 

  3. Luque-Otero M et alIncreased ventricular arrhythmias in hypertensives with left ventricular hypertrophy J Hypertens 1986 4 (Suppl 6) 566–567

    Google Scholar 

  4. Day CP, Mc Comb JM, Campbell RWF QT dispersion: an indication of arrhythmia risk inpatients with long QT intervals Br Heart J 1990 63 342–344

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bashir Y, Farrell T, Camm AJ Increased QT dispersion in survivors of acute myocardial infarction who subsequently develop ventricular arrhythmias or sudden death Pace 1990 13 561

    Google Scholar 

  6. Pye MP, Cobbe SM Mechanisms of ventricular arrhythmias in cardiac failure and hypertrophy Cardiovasc Res 1992 26 740–750

    Article  CAS  PubMed  Google Scholar 

  7. Barr CS et alQT dispersion and sudden unexpected death in chronic heart failure Lancet 1994 343 327–329

    Article  CAS  PubMed  Google Scholar 

  8. Buja G et alComparison of QT dispersion in hypertrophic cardiomyopathy betweenpatients with and without ventricular arrhythmias and sudden death Am J Cardiol 1993 72 973–976

    Article  CAS  PubMed  Google Scholar 

  9. James MA, Jones JV Ventricular arrhythmia in newly presenting hypertensivepatients compared with a matched normal population J Hypertens 1989 7 409–415

    Article  CAS  PubMed  Google Scholar 

  10. Bazett HC An analysis of the time-relations of electrocardiograms Heart 1920 7 353–370

    Google Scholar 

  11. Higham PD, Campbell RWF QT dispersion Br Heart J 1994 71 508–510

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Sokolow M, Lyon TP The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads Am Heart J 1949 37 161–186

    Article  CAS  PubMed  Google Scholar 

  13. Calvert A, Lown B, Gorlin R Ventricular premature beats and anatomically defined coronary heart disease Am J Cardiol 1977 39 627–634

    Article  CAS  PubMed  Google Scholar 

  14. Kuller L, Lillienfeld A, Fisher R An epidemiological study of sudden and unexpected deaths in adults Medicine 1967 46 341–361

    Article  CAS  PubMed  Google Scholar 

  15. Kreger BE, Cupples A, Kannel WB The electrocardiogram in prediction of sudden death: Framingham study experience Am Heart J 1987 114 377–382

    Article  Google Scholar 

  16. Kannel WB, Gordon T, Castellia WP, Margolis JR Electrocardiographic left ventricular hypertrophy and the risk of coronary artery disease. The Framingham study Ann Intern Med 1970 72 813–822

    Article  CAS  PubMed  Google Scholar 

  17. Dunn FG et alLeft ventricular hypertrophy and mortality in hypertension: an analysis of data from the Glasgow blood pressure clinic J Hypertens 1990 8 775–782

    Article  CAS  PubMed  Google Scholar 

  18. Mayet J et alLeft ventricular hypertrophy and QT dispersion in hypertension Hypertension 1996 28 791–796

    Article  CAS  PubMed  Google Scholar 

  19. Clarkson PB et alQT dispersion in essential hypertension QJM 1995 88 327–332

    CAS  PubMed  Google Scholar 

  20. Piccirillo G et alAutonomic modulation and QT interval dispersion in hypertensive subjects with anxiety Hypertension 1999 34 242–246

    Article  CAS  PubMed  Google Scholar 

  21. Karpanou EA et alRegression of left ventricular hypertrophy results in improvement of QT dispersion inpatients with hypertension Am Heart J 1998 136 765–768

    Article  CAS  PubMed  Google Scholar 

  22. Gonzalez-Juanatey JR et alReduction of QT dispersion during long-term treatment of systemic hypertension with enalapril Am J Cardiol 1998 81 170–174

    Article  CAS  PubMed  Google Scholar 

  23. Kulan K et alSignificance of QTc prolongation on ventricular arrhythmias inpatients with left ventricular hypertrophy secondary to essential hypertension Int J Cardiol 1998 64 179–184

    Article  CAS  PubMed  Google Scholar 

  24. Kennedy HL et alLong term follow-up of asymptomatic healthy subjects with frequent and complex ventricular arrhythmias N Engl J Med 1985 312 193–197

    Article  CAS  PubMed  Google Scholar 

  25. Surawicz B Prognosis of ventricular arrhythmias in relation to sudden cardiac death: therapeutic implications J Am Coll Cardiol 1987 10 435–447

    Article  CAS  PubMed  Google Scholar 

  26. Maron BJ, Savage DD, Wolfson JK, Epstein SE Prognostic significance of 24 hour electrocardiographic monitoring inpatients with hypertrophic cardiomyopathy: a prospective study Am J Cardiol 1981 48 252–257

    Article  CAS  PubMed  Google Scholar 

  27. McKenna WJ et alArrhythmia in hypertrophic cardiomyopathy: Influence on prognosis Br Heart J 1981 46 168–172

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Frimm C de C et alLeft ventricular hypertrophy predicts outcome of hypertension regardless of the type of ventricular arrhythmia present J Hum Hypertens 1999 13 617–623

    Article  Google Scholar 

  29. Ruberman W et alVentricular premature beats and mortality after myocardial infarction N Engl J Med 1977 297 750–757

    Article  CAS  PubMed  Google Scholar 

  30. Toyoshima H et alEffect of ventricular hypertrophy on conduction velocity of activation front in the ventricular myocardium Am J Cardiol 1982 49 1938–1945

    Article  CAS  PubMed  Google Scholar 

  31. Sideresis DA et alArrhythmogenic effect of high blood pressure: some observations on its mechanism Cardiovasc Res 1989 23 983–992

    Article  Google Scholar 

  32. Bikkina M, Larson MG, Levy D Asymptomatic ventricular arrhythmias and mortality risk in subjects with left ventricular hypertrophy J Am Coll Cardiol 1993 22 1111–1116

    Article  CAS  PubMed  Google Scholar 

  33. Galinier M et alPrognostic value of ventricular arrhythmias in systemic hypertension J Hypertens 1997 15 1779–1780

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan

    AM Saadeh

  2. Department of Medical Cardiology, Bristol Royal Infirmary, Bristol, UK

    JV Jones

Authors
  1. AM Saadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. JV Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saadeh, A., Jones, J. Predictors of sudden cardiac death in never previously treated patients with essential hypertension: long-term follow-up. J Hum Hypertens 15, 677–680 (2001). https://doi.org/10.1038/sj.jhh.1001255

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001255

Keywords

This article is cited by

Search

Advanced search

Quick links