QTc Interval Predicts Disturbed Circadian Blood Pressure Variation

Overview

Journal Open Med (Wars)

Specialty General Medicine

Date 2020 Mar 20

PMID 32190737

Authors

Liyuan Yan

Jianling Jin

Shili Jiang

Wei Zhu

Meiwen Gao

Xin Zhao

Jiamin Yuan

Affiliations

Soon will be listed here.

Abstract

Background: The relationship between electrocardiographic evaluation and circadian blood pressure (BP) variation in young and middle-aged hypertensive patients remains unknown.

Methods: A total of 171 hypertensive patients were included in the study. First, patients were divided into a young and middle-aged group and an elderly group. The two groups were then separately classified into three subgroups on the basis of circadian variation of BP as dippers, non-dippers and reverse-dippers. The electrocardiographic evaluation was calculated from 12-lead electrocardiography (ECG).

Results: QTc intervals were shortest in the dippers and longest in the reverse-dippers in the young and middle-aged group (QTc dipper: 416.53±18.37ms; non-dipper: 438.30±29.71ms; reverse-dipper: 444.93±25.47ms; for dipper vs non-dipper, and dipper vs reverse-dipper P<0.05). QTc interval was found to be an independent risk factor for the non-dipper BP pattern (Odds ratio 1.049; 95% CI 1.01-1.089; P=0.012) and reverse-dipper BP pattern (Odds ratio 1.051; 95% CI 1.007-1.098; P=0.023) in young and middle-aged hypertensive patients. No significant differences in other ECG parameters were found among the three subgroups in the young and middle-aged group.

Conclusion: Our study suggested that QTc interval might serve as a risk factor for non-dipper BP pattern and reverse-dipper BP pattern in young and middle-aged hypertensive patients.

References

Hermida R . Sleep-time ambulatory blood pressure as a prognostic marker of vascular and other risks and therapeutic target for prevention by hypertension chronotherapy: Rationale and design of the Hygia Project. Chronobiol Int. 2016; 33(7):906-36. DOI: 10.1080/07420528.2016.1181078. View

Hermida R, Ayala D, Mojon A, Fernandez J . Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int. 2010; 27(8):1629-51. DOI: 10.3109/07420528.2010.510230. View

Tisdale J, Jaynes H, Kingery J, Mourad N, Trujillo T, Overholser B . Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circ Cardiovasc Qual Outcomes. 2013; 6(4):479-87. PMC: 3788679. DOI: 10.1161/CIRCOUTCOMES.113.000152. View

Casale P, Devereux R, Kligfield P, Eisenberg R, Miller D, Chaudhary B . Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985; 6(3):572-80. DOI: 10.1016/s0735-1097(85)80115-7. View

Dekker J . The value of the heart-rate corrected QT-interval for cardiovascular risk stratification. Eur Heart J. 1999; 20(4):250-1. View

Myredal A, Friberg P, Johansson M . Elevated myocardial repolarization lability and arterial baroreflex dysfunction in healthy individuals with nondipping blood pressure pattern. Am J Hypertens. 2010; 23(3):255-9. DOI: 10.1038/ajh.2009.252. View

Aro A, Reinier K, Rusinaru C, Uy-Evanado A, Darouian N, Phan D . Electrical risk score beyond the left ventricular ejection fraction: prediction of sudden cardiac death in the Oregon Sudden Unexpected Death Study and the Atherosclerosis Risk in Communities Study. Eur Heart J. 2017; 38(40):3017-3025. PMC: 5837238. DOI: 10.1093/eurheartj/ehx331. View

Trinkley K, Page 2nd R, Lien H, Yamanouye K, Tisdale J . QT interval prolongation and the risk of torsades de pointes: essentials for clinicians. Curr Med Res Opin. 2013; 29(12):1719-26. DOI: 10.1185/03007995.2013.840568. View

. International Conference on Harmonisation; guidance on E14 Clinical Evaluation of QT/QTc Interval Prolongation and Proarrhythmic Potential for Non-Antiarrhythmic Drugs; availability. Notice. Fed Regist. 2005; 70(202):61134-5. View

10.

Dauphinot V, Gosse P, Kossovsky M, Schott A, Rouch I, Pichot V . Autonomic nervous system activity is independently associated with the risk of shift in the non-dipper blood pressure pattern. Hypertens Res. 2010; 33(10):1032-7. DOI: 10.1038/hr.2010.130. View

11.

Hermida R, Ayala D, Portaluppi F . Circadian variation of blood pressure: the basis for the chronotherapy of hypertension. Adv Drug Deliv Rev. 2007; 59(9-10):904-22. DOI: 10.1016/j.addr.2006.08.003. View

12.

Ma S, Zhao H, Wang Y . [Characteristic of blood pressure profile in elderly hypertensive patients with chronic kidney disease: a tertiary hospital-based study]. Zhonghua Yi Xue Za Zhi. 2016; 95(36):2938-42. View

13.

Whelton P, Carey R, Aronow W, Casey Jr D, Collins K, Himmelfarb C . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on.... Circulation. 2018; 138(17):e484-e594. DOI: 10.1161/CIR.0000000000000596. View

14.

Schwartz P, Woosley R . Predicting the Unpredictable: Drug-Induced QT Prolongation and Torsades de Pointes. J Am Coll Cardiol. 2016; 67(13):1639-1650. DOI: 10.1016/j.jacc.2015.12.063. View

15.

Routledge F, McFetridge-Durdle J, Dean C . Night-time blood pressure patterns and target organ damage: a review. Can J Cardiol. 2007; 23(2):132-8. PMC: 2650649. DOI: 10.1016/s0828-282x(07)70733-x. View

16.

Tanriverdi Z, Unal B, Eyuboglu M, Bingol Tanriverdi T, Nurdag A, Demirbag R . The importance of frontal QRS-T angle for predicting non-dipper status in hypertensive patients without left ventricular hypertrophy. Clin Exp Hypertens. 2017; 40(4):318-323. DOI: 10.1080/10641963.2017.1377214. View

17.

Tanindi A, Alhan A, Tore H . Tp-e/QT ratio and QT dispersion with respect to blood pressure dipping pattern in prehypertension. Blood Press Monit. 2014; 20(2):69-73. DOI: 10.1097/MBP.0000000000000090. View

18.

Schwartz P, Wolf S . QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation. 1978; 57(6):1074-7. DOI: 10.1161/01.cir.57.6.1074. View

19.

Passino C, Magagna A, Conforti F, Buralli S, Kozakova M, Palombo C . Ventricular repolarization is prolonged in nondipper hypertensive patients: role of left ventricular hypertrophy and autonomic dysfunction. J Hypertens. 2003; 21(2):445-51. DOI: 10.1097/00004872-200302000-00038. View

20.

Ohkubo T, Hozawa A, Yamaguchi J, Kikuya M, Ohmori K, Michimata M . Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens. 2002; 20(11):2183-9. DOI: 10.1097/00004872-200211000-00017. View