PREVALENCE OF ECTOPIC VENTRICULAR ACTIVITY AFTER LEFT-VENTRICULAR MASS REGRESSION

To assess the effects of left ventricular mass reduction on the prevalence of ventricular ectopic activity, we conducted a double-blind, placebo-controlled trial measuring ambulatory 48 h premature ventricular depolarizations in 27 patients with mild-to-moderate hypertension and an increased left ventricular mass index. Data was obtained at baseline and 6 +/- 2 months after randomization to either 25 mg captopril or placebo twice a day. Patients on captopril attained reduction in blood pressure from 167 +/- 11/103 +/- 6 to 136 +/- 10/85 +/- 5 mm Hg W = .001), left ventricular mass index regression from 149 +/- 17 to 96 +/- 23 g/m2 (P = .001), and ventricular ectopic activity reduction from 413 +/- 172 to 77 +/- 27 ventricular extrasystoles/day (P = .001). Patients on placebo had no significant change in blood pressure (from 162 +/- 11/101 +/- 6 at baseline to 160 +/- 8/100 +/- 8 mm Hg after 6 months; P = NS). In the placebo group left ventricular mass index increased from 155 +/- 40 to 182 +/- 51 g/m2 (p = .01), and ventricular ectopic activity decreased from 634 +/- 293 to 562 +/- 260 ventricular extrasystoles/day (P = NS). Eight out of 14 patients on captopril (57%) and 1 out of 13 patients on placebo (8%) achieved reduction > 85% in ventricular ectopic activity per day (P = .004). Using multivariate logistic regression analysis, left ventricular mass index regression and reduction in systolic blood pressure were the most important correlates for this effect. It is concluded that in mild to moderate hypertensives with left ventricular hypertrophy, regression in left ventricular mass index results in significant decrease in the prevalence of ventricular ectopic activity.