ABC | Volume 112, Nº1, January 2019

Original Article Eyuboglu & Akdeniz Prehypertension and fragmented QRS Arq Bras Cardiol. 2019; 112(1):59-64 Table 1 – Baseline demographic and clinical characteristics of the study population according to blood pressure pattern All Patients (n:216) Control (n:61) Dippers (n:83) Non-dippers (n:72) p* Age (years) 50.5 ± 4.3 50.7 ± 4.5 50.1 ± 4.6 50.7 ± 3.7 0.651 Female gender, n (%) 99 (45.8) 30 (49.2) 39 (47.0) 30 (41.7) 0.664 Diabetes, n (%) 18 (8.3) 5 (8.2) 7 (8.4) 6 (8.3) 0.999 Smoking, n (%) 38 (17.6) 10 (16.4) 11 (13.3) 17 (23.6) 0.232 Fragmented QRS, n (%) 30 (13.9) 4 (6.6) 10 (12.0) 16 (22.2) 0.028 Number of leads with fragmented QRS, n (%) 2 27 (90.0) 4 (100.0) 9 (90.0) 14 (87.5) 0.765 3 3 (10.0) 0 (0.0) 1 (10.0) 2 (12.5) 24h mean SBP, mmHg 122.5 ± 5.2 114.8 ± 1.7 124.8 ± 2.1 126.4 ± 1.7 < 0.001 24h mean DBP, mmHg 74.3 ± 5.3 66.2 ± 1.8 77.1 ± 1.2 78.0 ± 1.0 < 0.001 Day SBP, mmHg 128.7 ± 1.0 116.2 ± 1.6 128.9 ± 1.1 128.4 ± 0.8 < 0.001 Day DBP, mmHg 78.9 ± 1.0 66.0 ± 1.8 78.8 ± 1.2 79.1 ± 0.6 0.175 Night SBP, mmHg 117.6 ± 3.4 113.4 ± 1.7 114.8 ± 2.1 120.8 ± 0.8 < 0.001 Night DBP, mmHg 72.0 ± 3.4 66.4 ± 1.7 69.0 ± 0.9 75.5 ± 1.5 < 0.001 LVEF (%) 63.1 ± 2.4 63.2 ± 2.4 62.8 ± 2.5 63.3 ± 2.4 0.396 Hemoglobin (g/dl) 14.3 ± 1.5 14.0 ± 1.5 14.5 ± 1.5 14.4 ± 1.5 0.175 WBC (10 3 /ml) 7.7 ± 1.0 7.9 ± 0.9 7.5 ± 1.1 7.8 ± 1.0 0.071 Creatinine (mg/dl) 0.8 ± 0.1 0.8 ± 0.1 0.8 ± 0.1 0.8 ± 0.1 0.688 LDL (mg/dl) 108.8 ± 19.7 109.5 ± 18.3 106.8 ± 20.7 110.6 ± 19.7 0.359 HDL (mg/dl) 43.0 ± 6.2 43.4 ± 6.2 43.8 ± 6.1 41.7 ± 6.1 0.074 Triglycerides (mg/dl) 135.7 ± 23.1 133.8 ± 21.7 135.7 ± 23.7 137.3 ± 23.8 0.582 LVEDD, mm 45.2 ± 3.1 45.1 ± 3.2 45.3 ± 3.3 45.1 ± 3.1 0.429 IVST, mm 9.8 ± 1.1 9.7 ± 1.0 9.8 ± 1.1 9.8 ± 1.1 0.613 LA diameter, mm 35.8 ± 3.8 35.7 ± 3.6 35.8 ± 3.8 35.8 ± 3.8 0.374 SBP: systolic blood pressure; DBP: diastolic blood pressure; LVEF: left ventricular ejection fraction; WBC: White blood cell count; LDL: low-density lipoprotein; HDL: high-density lipoprotein; LVEDD: left ventricle end-diastolic diameter; IVST: interventricular septum thickness; LA: left atrium. *One-way ANOVA was performed to study differences among the three groups. of non-homogeneous patients. Therefore, early identification of high-risk prehypertensives could lead to adequate prevention. Previous studies reported that deteriorated circadian blood pressure variability in prehypertensive patients may be associated with repolarization abnormalities detected by ECG. 15 However, as a marker of depolarization abnormality, the importance of fQRS in prehypertensive patients is not clear. fQRS is a sign of inhomogenous ventricular conduction caused by myocardial scar, ischemia, or fibrosis. 8 It has been shown that fQRS is a predictor of mortality and adverse cardiovascular outcomes in various cardiovascular diseases. 6-8 Additionally, fQRS is a well described fibrotic factor in Table 2 – Multinomial logistic regression analysis shows fragmented QRS is a predictor of non-dipping in prehypertensive patients Blood Pressure a Variable p Odds Ratio 95% Confidence Interval Dipper Prehypertension Fragmented QRS 0.279 1.952 0.582-6.547 Non-dipper Prehypertension Fragmented QRS 0.017 4.071 1.281-12.936 a : The reference category is: Control. hypertension. 11,16 It has been demonstrated that the frequency of fQRS is significantly higher in hypertensive patients than in normotensives, 9 and non-dipper hypertensive patients have higher frequency of fQRS on ECG compared to hypertensive dippers. 10,11 These studies revealed that increased blood pressure levels and elevated nighttime blood pressure levels are associated with the presence of fQRS on ECG in hypertensive patients, which indicates the higher fibrotic burden within myocardium in these patients. Our study demonstrated that non-dipping blood pressure patterns are significantly associated with the presence of fQRS on ECG in prehypertensive patients, similarly to in 62