Abstract
A prolonged QT interval is a risk factor for ischemic heart disease in hypertensive subjects. Heart rate variability (HRV) is both an index of autonomic function and an important prognostic factor in several diseases. The aim of the present study was to evaluate the relation between a prolonged QT interval and autonomic nervous system function in patients with untreated uncomplicated essential hypertension. Two hundred and fifteen untreated patients with essential hypertension underwent a Holter ECG equipped with software dedicated to HRV and QT analyses. Nine percent of the patients showed a corrected QT (QTc) ≥440 ms. The HRV indexes in the time domain (SDNN, SDNN index, RMSSD, and pNN50) were significantly reduced in the patients with a prolonged QTc compared to those with a normal QTc (SDNN 24 h: 126.4±29.9 vs. 143.9±35.4 ms, p=0.02; SDNN index [nighttime]: 85.9±32.4 vs. 115.5±36.7 ms, p=0.0006; RMSSD 24 h: 22.2±7.7 vs. 31.2±13.0 ms, p=0.0007; pNN50 24 h: 4.4±4.9 vs. 9.7±8.4%, p=0.0006). The linear correlation analysis between QTc length and HRV parameters showed a significant negative correlation with all the time-domain indexes. Such a correlation was maintained for RMSSD 24 h, pNN50 24 h and SDNN index (nighttime) after correction for gender and age. The present study shows that, even prior to the development of cardiac hypertensive disease, a prolongation of the QTc and a reduced HRV, both markers of cardiovascular risk, coexist in a proportion of patients with untreated essential hypertension. Further studies are warranted to evaluate whether the combination of such markers can identify hypertensive patients at risk for life-threatening arrhythmias and sudden death.
Similar content being viewed by others
Article PDF
References
Schouten EG, Dekker JM, Meppelink P, Kolk FJ, Vanderbroucke JP, Pool J : QT interval prolongation predicts cardiovascular mortality in an apparently healthy population. Circulation 1991; 84: 1516–1523.
Sawicki PT, Dahne R, Bender R, Berger M : Prolonged QT interval as a predictor of mortality in diabetic nephropathy. Diabetologia 1996; 39: 77–81.
Schwartz PJ, Wolf S : QT interval prolongation as a predictor of sudden death in patients with myocardial infarction. Circulation 1978; 57: 1074–1077.
Davey PP, Bateman J, Mulligan IP, Forfar C, Barlow C, Hart G : QT interval dispersion in chronic heart failure and left ventricular hypertrophy: relation to autonomic nervous system and Holter tape abnormalities. Br Heart J 1994; 71: 268–273.
Oikarinen L, Nieminen MS, Viitasalo M, et al: QRS duration and QT interval predict mortality in hypertensive patients with left ventricular hypertrophy. The Losartan Intervention for Endpoint Reduction in Hypertension Study. Hypertension 2004; 43: 1029–1034.
Kulan K, Ural D, Komsuoglu B, Agacdiken A, Goldeli O, Komsuoglu SS : Significance of QTc prolongation on ventricular arrhythmias in patients with left ventricular hypertrophy secondary to essential hypertension. Int J Cardiol 1998; 64: 179–184.
Schillaci G, Pirro M, Ronti T, et al: Prognostic impact of prolonged ventricular repolarization in hypertension. Arch Intern Med 2006; 166: 909–913.
Bexton RS, Vallin HO, Camm AJ : Diurnal variation of the QT interval—influence of the autonomic nervous system. Br Heart J 1986; 55: 253–258.
Murakawa Y, Yamashita T, Ajiki K, et al: Is the QT interval an indicator of autonomic state? Jpn Heart J 2000; 41: 713–721.
Ong JJC, Sarma JMS, Venkataraman K, et al: Circadian rhythmicity of heart rate and QTc interval in diabetic autonomic neuropathy: implications for the mechanism of sudden death. Am Heart J 1993; 125: 744–752.
Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ : Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987; 59: 256–262.
Pfeifer MA, Cook D, Brodsky J, et al: Quantitative evaluation of cardiac parasympathetic activity in normal and diabetic man. Diabetes 1982; 31: 339–345.
Liao D, Cai J, Barnes RW, et al: Association of cardiac autonomic function and the development of hypertension: the ARIC Study. Am J Hypertens 1996; 9: 1147–1156.
Chakko S, Mulingtapang FR, Huikuri HV, Kessler KM, Materson BJ, Myerburg RJ : Alteration in heart rate variability and its circadian rhythm in hypertensive patients with left ventricular hypertrophy free of coronary artery disease. Am Heart J 1993; 126: 1364–1372.
Glynn RJ, L'Italien GJ, Sesso HD, Jackson EA, Buring JE : Development of predictive models for long-term cardiovascular risk associated with systolic and diastolic blood pressure. Hypertension 2002; 39: 105–110.
Veglio M, Borra M, Stevens LK, Fuller JH, Cavallo Perin P : The relation between QTc interval prolongation and diabetic complications. The EURODIAB IDDM Complication Study Group. Diabetologia 1999; 42: 68–75.
Dekker JM, Schouten EG, Klootwijk P, Pool J, Kromhout D : Association between QT interval and coronary heart disease in middle-aged and elderly men. The Zutphen Study. Circulation 1994; 90: 779–785.
Facchini M, Malfatto G, Ciambellotti F, et al: Markers of electrical instability in hypertensive patients with and without ventricular arrhythmias. Are they useful in identifying patients with different risk profiles? J Hypertens 2000; 18: 763–768.
Kleiman RB, Houser SR : Outward currents in normal and hypertrophied feline ventricular myocytes. Am J Physiol 1989; 256: H1450–H1461.
Guzzetti S, Piccaluga E, Casati R, et al: Sympathetic predominance in essential hypertension: a study employing spectral analysis of heart rate variability. J Hypertens 1988; 6: 711–717.
Dassi S, Balsam´ M, Guzzetti S, et al: Twenty-four hour power spectral analysis of heart rate variability and of arterial pressure values in normotensive and hypertensive subjects. J Hypertens 1991; 9: S72–S73.
Perkiomaki JS, Ikaheimo MJ, Pikkuiamsa SM, et al: Dispersion of the QT interval and autonomic modulation of heart rate in hypertensive men with and without left ventricular hypertrophy. Hypertension 1996; 28: 16–21.
Petretta M, Marciano F, Bianchi I, et al: Power spectral analysis of heart period variability in hypertensive patients with left ventricular hypertrophy. Am J Hypertens 1995; 8: 1206–1213.
Abildskov JA : Adrenergic effects of the QT interval of the electrocardiogram. Am Heart J 1976; 92: 210–216.
Browne KF, Zipes DP, Heger JJ, Prystowsky EN : Influence of the autonomic nervous system on the QT interval in man. Am J Cardiol 1982; 50: 1099–1103.
Passino C, Franzoni F, Gabutti A, Poletti R, Galetta F, Emdin M : Abnormal ventricular repolarization in hypertensive patients: role of sympatho-vagal imbalance and left ventricular hypertrophy. Int J Cardiol 2004; 97: 57–62.
Harada T, Abe J, Shiotani M, Hamada Y, Horii I : Effect of autonomic nervous function on QT interval in dogs. J Toxicol Sci 2005; 3: 229–237.
Opthof T, Dekker LR, Cornel R : Interaction of sympathetic and parasympathetic nervous system on ventricular refractoriness assessed by local fibrillation intervals in the canine heart. Cardiovasc Res 1993; 27: 753–759.
Ishida S, Nagakawa M, Fujino T, Yonemochi H, Saikawa T, Ito M : Circadian variation of QT interval dispersion. J Electrocardiol 1997; 30: 205–210.
Valensi P, Johnson NB, Maison-Blanche P, Extramania F, Motte G, Coumel P : Influence of cardiac autonomic neuropathy on heart rate dependence of ventricular repolarization in diabetic patients. Diabetes Care 2002; 25: 918–923.
Piccirillo G, Viola E, Nocco M, et al: Autonomic modulation and QT interval dispersion in hypertensive subjects with anxiety. Hypertension 1999; 34: 242–246.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maule, S., Rabbia, F., Perni, V. et al. Prolonged QT Interval and Reduced Heart Rate Variability in Patients with Uncomplicated Essential Hypertension. Hypertens Res 31, 2003–2010 (2008). https://doi.org/10.1291/hypres.31.2003
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.31.2003
Keywords
This article is cited by
-
Murine model of left ventricular diastolic dysfunction and electro-mechanical uncoupling following high-fat diet
International Journal of Obesity (2020)
-
Preference for salt contributes to sympathovagal imbalance in the genesis of prehypertension
European Journal of Clinical Nutrition (2013)
-
QT interval prolongation and the risks of stroke and coronary heart disease in a general Japanese population: the Hisayama study
Hypertension Research (2010)