Hypertension, left ventricular hypertrophy, and sudden death

Abstract

Left ventricular hypertrophy (LVH), a form of end-organ damage in hypertension, is associated with increased incidence of sudden cardiac death (SCD). This review explores the possible mechanisms behind this phenomenon. SCD in LVH could be thrombotic/ischemic or arrhythmic (eg, myocardial ischemia, even in the absence of significant coronary artery disease, may be one important factor). Abnormalities of flow-mediated dilatation, endothelial function, and a hypercoagulable state are well-observed abnormalities in association with hypertension and LVH, although their precise contributory role is as yet undefined in the pathogenesis of sudden death. Electrophysiologic abnormalities are also well documented in LVH, and such patients are more predisposed to arrhythmias. In the past decade, many studies have investigated the regression of LVH, and recent studies are addressing whether the latter translates into a prognostic benefit.

Echocardiographic changes in patients with malignant phase hypertension: The West Birmingham Malignant Hypertension Register

“…[16][17][18] Indeed, the identification of LVH in patients with MHT is of great importance, in view of the relationship between LVH and arrhythmias, as well as sudden death. 19,20 These arrhythmias could in part explain the increased mortality seen in untreated MHT patients, 3 or in subjects where the treatment may be suboptimal. 7 The presence of severe LVH in our patients suggests that even in the undiagnosed patients, the hypertension could have been long standing but undetected.…”

Risk Assessment for Sudden Cardiac Death in Dialysis Patients

“…25 Significant LVH is a common feature of uremic cardiomyopathy, with 60% to 80% of patients with ESRD commencing dialysis while showing echocardiographic evidence of LVH. 26 In addition to systemic hypertension, both as a common cause of ESRD and as a consequence of it, other factors unique to ESRD, such as hyperparathyroidism, high cardiac output due to anemia and arteriovenous fistula, and activation of the neuroendocrine systems, contribute to this high incidence of LVH.…”

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

“…4 The development of hypertension and its relationship to CVD is multifactorial and likely includes both environmental and physiological/genetic components, including endothelial dysfunction, subendocardial fibrosis, and left ventricular hypertrophy (LVH). 5,6 The relationship of LVH to cardiac death 6,7 is of particular importance in blacks because of the higher prevalence of hypertension associated LVH in this ethnic group. Echocardiographic data from the Coronary Artery Risk Development in Young Adults study showed that LV mass was higher in blacks than in whites and correlated with systolic blood pressure.…”