Cardiac rhythm in hypertension assessed through 24 hour ambulatory electrocardiographic monitoring. Effects of load manipulation with atenolol, verapamil, and nifedipine

A. Loaldi, M. Pepi, P. G. Agostoni, C. Fiorentini, S. Grazi, P. Della Bella, M. D. Guazzi

Research output: Contribution to journalArticle

Abstract

In systemic hypertension left ventricular wall stress (afterload) is reduced and function enhanced, compared with normal, in the presence of concentric hypertrophy; the opposite occurs when hypertrophy is combined with dilatation. In this study we tested the hypothesis that cardiac rhythm may be related, in part, to the interacting variables: left ventricular structure, afterload, and function. Eighty-five primary hypertensives were divided into three groups: group 1 (24 cases with normal sized heart), group 2 (33 cases with concentric hypertrophy), and group 3 (28 cases with hypertrophy and dilatation). Cardiac rhythm, through 24-hour ambulatory electrocardiographic monitoring, and end-systolic left ventricular circumferential wall stress were investigated before and after seven days of treatment with atenolol, verapamil, and nifedipine in groups 1 and 2, and with the two calcium antagonists in group 3. Atrial and ventricular extrasystoles were recorded in 75 to 100% of the subjects in the control group (13 normotensives) and in the hypertensive groups. Average 24 hour atrial ventricular extrasystoles in group 1, and ventricular extrasystoles in group 2, were similar to normal before treatment and were not affected by drugs; changes in circumferential wall stress with treatment were comparable. In group 2 the number of atrial extrasystoles in 24 hours was significantly higher than in all the other groups. They were not influenced by changes in wall stress, and were interpreted as related to the atrial 'booster pump' action in the presence of concentric hypertrophy. In group 3 a great number of ventricular extrasystoles was associated with the highest baseline left ventricular afterload; circumferential wall stress and ventricular extrasystoles were poorly affected by verapamil, while the remarkable circumferential wall stress reduction caused by nifedipine was paralleled by an obvious decrease in ventricular extrasystoles. These data support the possibility that in systemic hypertension a relation exists between cardiac structure, load, and rhythm, and that ventricular arrhythmias may benefit from effective left ventricular unloading.

Original languageEnglish
Pages (from-to)118-126
Number of pages9
JournalBritish Heart Journal
Volume50
Issue number2
Publication statusPublished - 1983

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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