Hypertension, left ventricular hypertrophy and sudden death

pp 161-167

Abstract

Left ventricular hypertrophy (LVH) has been identified as a powerful risk factor for sudden death and other cardiovascular morbidity and mortality. LVH has been documented to give rise to ventricular ectopy even in the absence of myocardial ischemia. Mechanisms of ectopic impulse generation in L VH are multifactorial and invplve enlarged myocytes, focal areas of fibrosis, and subendocardial ischemia as well as medial hypertrophy of the coronary arteries impeding homogeneous impulse propagation throughout the myocardium. LVH can be reduced by specific antihypertensive therapy although not all antihypertensive agents are equipotent in this regard. A reduction of LVH with calcium antagonists and possibly with beta-blockers has been shown to diminish ventricular arrhythmias. Whether or not such a reduction of L VH and suppression of ventricular ectopy will improve its unfavorable prognosis remains to be determined.