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高血压患者心室复极分析:夜间血压波动的影响

Analysis of Ventricular Repolarization in Hypertensive Patients: Influence of Nocturnal Blood Pressure Dipping.

作者信息

Goulart Marco Aurélio, Moreira Dalmo Antonio Ribeiro, Cesena Fernando Yue, Souza Jonathan Batista, Laurinavicius Antonio Gabriele, Consolim-Colombo Fernanda Marciano, Sousa Márcio Gonçalves de

机构信息

Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.

Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.

出版信息

Arq Bras Cardiol. 2025 Apr;122(4):e20240725. doi: 10.36660/abc.20240725.

Abstract

Changes in ventricular repolarization are associated with ventricular arrhythmias and higher mortality. The association between a non-dipper blood pressure pattern and changes in ventricular repolarization remains controversial. This study sought to compare ventricular repolarization measurements (QT interval, QTc, Tp-Te, Tp-Te/QT, and QTd) in hypertensive dippers and non-dippers. Secondary objectives are to compare measurements between controlled and uncontrolled hypertensive patients, as well as resistant and non-resistant hypertensive patients. This observational, cross-sectional study involved patients monitored in a Hypertension Service. The level of significance adopted in the statistical analysis was 5%. A total of 130 participants were admitted. The mean age was 67.4 years, with 72% presenting some form of target organ damage. Repolarization measurements did not differ between dippers and non-dippers. However, within the resistant hypertension group, when compared to the non-resistant, differences were observed in the QT interval in V5 (433.3 ms vs. 420.9 ms, p = 0.046), Tp-Te in both V2 (85.4 ms vs. 78.7 ms, p = 0.049) and V5 (84.6 ms vs. 74.6 ms, p = 0.006), Tp-Te/QT in V5 (0.19 vs. 0.18, p = 0.019), Sokolow-Lyon index (18.8 mm vs. 15.7 mm, p = 0.011), and Cornell index (14.2 mm vs. 11.2 mm, p = 0.002), aged-adjusted values. In this high cardiovascular risk hypertensive population, no difference in repolarization measures was found between dippers and non-dippers. However, this is the first study to demonstrate increased ventricular repolarization measures in patients with resistant hypertension.

摘要

心室复极化的改变与室性心律失常及更高的死亡率相关。非勺型血压模式与心室复极化改变之间的关联仍存在争议。本研究旨在比较高血压勺型和非勺型患者的心室复极化测量指标(QT间期、校正QT间期、Tp-Te间期、Tp-Te/QT比值和QT离散度)。次要目标是比较血压控制和未控制的高血压患者以及顽固性和非顽固性高血压患者之间的测量指标。这项观察性横断面研究纳入了在高血压门诊接受监测的患者。统计分析采用的显著性水平为5%。共纳入130名参与者。平均年龄为67.4岁,72%的患者存在某种形式的靶器官损害。勺型和非勺型患者的复极化测量指标无差异。然而,在顽固性高血压组中,与非顽固性高血压组相比,观察到V5导联的QT间期(433.3毫秒对420.9毫秒,p = 0.046)、V2导联(85.4毫秒对78.7毫秒,p = 0.049)和V5导联(84.6毫秒对74.6毫秒,p = 0.006)的Tp-Te间期、V5导联的Tp-Te/QT比值(0.19对0.18,p = 0.019)、索科洛夫-里昂指数(18.8毫米对15.7毫米,p = 0.011)和康奈尔指数(14.2毫米对11.2毫米,p = 0.002)存在差异,这些均为年龄校正后的值。在这个心血管风险较高的高血压人群中,勺型和非勺型患者的复极化测量指标未发现差异。然而,这是第一项证明顽固性高血压患者心室复极化测量指标增加的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c44d/12108120/4b13df4c9818/0066-782x-abc-122-4-e20240725-gf01.jpg

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