The relationship between white coat hypertension and the index of cardiac electrophysiological balance (ICEB)

Yıl 2022, Cilt: 5 Sayı: 3, 917 - 921, 30.05.2022

Murat Karamanlıoğlu , Ekrem Şahan

https://doi.org/10.32322/jhsm.1029715

Öz

Aim: The index of cardiac electrophysiological balance (ICEB) is a new marker that can show the potential for ventricular arrhythmia and indicate the balancebetween ventricular depolarization and repolarization. A tendency toward ventricular arrhythmia has been shown innon-dipper hypertension and prehypertensive patients in various studies. White coat hypertension (WCH) has been shown to be associated with target organ damage and the actual development of hypertension. In this study, we aimed to evaluate the effect of dipper and non-dipper patterns on the ICEB in patients diagnosed with WCH.
Material and Method: A total of 108 patients were included in this study. Patients were divided into two groups as dipper and non-dipper patterns according to ABPM. QT/QRS (ICEB) and cQT/QRS (ICEBc) were recorded with computerized interpretation of the electrocardiogram.
Results: While electrocardiographic parameters including heart rate, PR interval, QT interval, cQT interval, and ICEB were similar in both groups (p>.05), in the non-dipper group, QRS duration was lower (p=.017) and ICEBc was higher (p=.001).
Conclusion: ICEBc may predict asusceptibility to ventricular arrhythmias in WCH patients. Therefore, non-dipper WCH patients with a high ICEBc should be followed for arrhythmia outcomes in addition to hypertensive outcomes.

Anahtar Kelimeler

White coat hypertension, non-dipper pattern, the index of cardiac electrophysiological balance, electrocardiography, ventricular arrhythmia, QT interval.

Kaynakça

• Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESHguidelines for themanagement of arterial hypertension. Eur Heart J 2018; 39: 3021-104.
• BenDov IZ, Kark JD, Mekler J, Shaked E, Bursztyn M. The white coat phenomenon is benign in referred treated patients: a 14 year ambulatory blood pressure mortality study. J Hypertens 2008; 26: 699-705.
• Pierdomenico SD, Lapenna D, Di Mascio R, Cuccurullo F. Short and long-term risk of cardiovascular events in white coat hypertension. J Hum Hypertens 2008; 22: 408-14.
• Ohkubo T, Hozawa A, Yamaguchi J, et al. Prognostic significance of the nocturnal decline in blood pressure in individuals with andwithout high 24-h blood pressure: the Ohasama study J Hypertens 2002; 20: 2183–9.
• Fukuda M, Munemura M, Usami T, et al. Nocturnal blood pressure iselevated with natriuresis and proteinuria as renal function deteriorates in nephropathy. Kidney Int 2004; 65: 621–5
• McLenachan JM, Henderson E, Morris KI, Dargie HJ. Ventricular arrhythmias in patients with hypertensive left ventricular hypertrophy. N Engl J Med 1987; 317: 787–92.
• Pringle SD, Dunn FG, Macfarlane PW, McKillop JH. Significance of ventricular arrhythmias in systemic hypertension withleft ventricular hypertrophy. Am J Cardiol 1992; 69: 913–7.
• Siegel D, Cheitlin MD, Black DM, Seel. Risk of ventricular arrhythmias in hypertensive men with left ventricular hypertrophy. Am J Cardiol 1990; 65: 742–7.
• Eyuboglu M, Akdeniz B. Association between non-dipping and fragmented QRS complexes in prehypertensive patients. Arq Bras Cardiol 2019; 112: 59-64.
• Tanriverdi Z, Unal B, Eyuboglu M, et al. The importance of frontal QRS-T angle forpredicting non-dipper status in hypertensive patients without left ventricular hypertrophy. Clin Exp Hypertens 2018; 40: 318-23.
• Panikkath R, Reinier K, Uy-Evanado A, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increasedrisk of sudden cardiac death. Circ Arrhythm Electrophysiol 2011; 4: 441–7.
• Algra A, Tijssen JG, Roelandt JR, Pool J, Lubsen J. QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death dueto cardiac arrest. Circulation 1991; 83: 1888–94.
• Gupta P, Patel C, Patel H, et al. T(p-e)/QTratio as an index of arrhythmogenesis. J Electrocardiol 2008; 41: 567–74.
• Akboga MK, Gulcihan Balci K, Yilmaz S, et al. Tp-e interval and Tp-e/QTc ratio as novel surrogate markers for prediction of ventricular arrhythmic events in hypertrophic cardiomyopathy. Anatol J Cardiol 2017;18: 48–53
• Robyns T, Lu HR, Gallacher DJ, et al. Evaluation of index of cardio-electrophysiological balance (iCEB) as a new biomarker for the identification of patients at increased arrhythmic risk. Ann Noninvasive Electrocardiol 2016; 21: 294–304.
• Lu HR, Yan GX, Gallacher DJ, et al. A new biomarker–index of cardiac electrophysiologicalbalance (iCEB)–plays an important role in drug-induced cardiac arrhythmias: beyond QT-prolongation and Torsades de Pointes (TdPs). J Pharmacol Toxicol Methods 2013; 68: 250–9
• Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiography 2015; 28: 1-39.
• Mancia G, Bombelli M, Facchetti R, et al. Long-term risk of sustained hypertension in white-coat or masked hypertension. Hypertension 2009; 54: 226-32.
• Sivén SSE, Niiranen TJ, Kantola IM, et al. White-coat and masked hypertension as risk factors for progression to sustained hypertension: the Finn-home study. J Hypertens 2016; 34: 54–60.
• Fukuhara M, Arima H, Ninomiya T, et al. White-coatand masked hypertension are associated with carotidatherosclerosis in a general population: the Hisayama study. Stroke 2013; 44: 1512-7
• Cuspidi C, Sala C, Tadic M, et al. Is white-coat hypertension a risk factor for carotid atherosclerosis? A review and meta-analysis. Blood Press Monit 2015; 20: 57–63.
• Gustavsen PH, Høegholm A, Bang LE, et al. White coat hypertension is a cardiovascular risk factor: a 10-yearfollow-up study. J Hum Hypertens 2003; 17: 811–7
• Özdemir L, Sökmen E. Effect of habitual cigarette smoking on the index of cardiac electrophysiological balance in apparently healthy individuals J Electrocardiol 2020; 59: 41-4.
• Efe SC, Oz A, Guven S, et al. Evaluation of index of cardiac-electrophysiological balance as arrhythmia predictor in bonsai users. Minerva Cardioangiol 2020; 68: 559-66.
• An HR, Park S, Yoo TH, et al. Non-dipper status and left ventricular hypertrophy as predictors of incident chronic kidney disease. J Korean Med Sci 2011; 26: 1185–90.
• 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: 255–9.
• Grassi G, Seravalle G, Trevano FQ, et al. Neurogenic abnormalities in masked hypertension. Hypertension 2007; 50: 537–542.
• Abildskov JA. Adrenergic effects of the QT interval of the electrocardiogram. Am Heart J 1976; 92: 210–6.
• Kohara K, Nishida W, Maguchi M, Hiwada K. Autonomic nervous function in non-dipper essential hypertensive subjects. Evaluation by power spectral analysis of heart rate variability. Hypertension 1995; 26: 808–14.
• Ino-Oka E, Yumita S, Sekino H, et al. The effects of physical activity and autonomic nerve tone on the daily fluctuation of blood pressure. Clin Exp Hypertens 2004; 26: 129–36.