Diuretics, arrhythmias and silent myocardial ischaemia in hypertensive patients.

Patients with high blood pressure have an increased risk of sudden death compared to the normotensive population. In the highest quintile of patients with systolic blood pressure above 155 mmHg, the risk of sudden death is 3.2 greater than those in the lowest quintile. Ventricular premature contractions without known coronary artery disease also increase the risk of sudden death. Other known risk factors in this regard are age, smoking, obesity and left ventricular hypertrophy. Hypertensive patients have an increased prevalence of ventricular arrhythmias which is most pronounced in those with left ventricular hypertrophy. However, a causal relationship between ventricular arrhythmias and sudden death is uncertain. Existing data do not allow any firm conclusion as to the effects of antihypertensive treatment on such arrhythmias or on the risk of sudden death. Silent ischaemia is not uncommon in patients with hypertension but, so far, no consistent relation with coronary artery disease, left ventricular hypertrophy or neurohormonal abnormalities has been demonstrated. Silent ischaemia is an independent predictor for the development of cardiac events in patients with hypertension and may be a predictor for sudden death in these patients. Ninety-two percent of patients with ventricular tachycardia (VT) and silent myocardial ischaemia can be expected to develop morbid cardiac events compared with only 37% of those who have neither VT or silent ischaemia. At present, there is no information on the influence of diuretics on silent ischaemia in hypertensive patients. It can be concluded that both ventricular arrhythmias and silent ischaemia are important and independent risk factors for cardiac events in hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)