Characteristics of Circadian Blood Pressure Pattern of Hypertensive Patients According to Localization of Fragmented QRS

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ORIGINAL ARTICLE

Characteristics of Circadian Blood Pressure Pattern of Hypertensive Patients According to Localization of Fragmented QRS on Electrocardiography Mehmet Eyuboglu1  Received: 12 August 2020 / Accepted: 3 November 2020 © Italian Society of Hypertension 2020

Abstract Introduction  A narrow fragmented QRS complex (fQRS) indicates myocardial fibrosis and hypertensive cardiomyopathy in hypertensive patients. However, no study has investigated the importance of localization of fQRS on electrocardiography (ECG) in these subjects. Aim  To investigate the association between circadian blood pressure (BP) pattern and localization of fQRS on ECG. Methods  A total of 291 hypertensive patients who had fQRS in anterior or inferior leads were included into the study. Patients were divided into two groups according to localization of fQRS in inferior or anterior leads. All patients underwent a 24-h ambulatory blood pressure monitoring for detailed evaluation of circadian BP pattern. The association between localization of fQRS and non-dipping was investigated. Results  Among study population, 182 (62.5%) patients had fQRS in inferior leads and 109 (37.5%) patients had fQRS in anterior leads. The frequency of patients with non-dipping BP pattern was significantly higher in patients with fQRS in anterior leads compared to patients with fQRS in inferior leads (47.7% vs 24.1%, p  10% decrease in nighttime systolic and diastolic BP levels, and non-dipper BP pattern was defined as less than 10% decrease in systolic and diastolic BP levels according to daytime values.

2.2 Electrocardiography and Fragmented QRS A standard 12-lead surface ECG was obtained from the all patients and ECGs were analyzed by two independent cardiologists who were totally blinded to the study. If there was a disagreement, the final decision regarding the presence of fQRS was reached by mutual agreement. The fQRS included various morphologies of the QRS ( 1 Rʹ (fragmentation) in 2 contiguous leads, corresponding to a major coronary artery territory [15]. Finally, the patients were divided into two groups according to localization of fQRS in inferior or anterior leads.

2.3 Statistical Analysis Statistical analyses were performed with SPSS software version 22.0 (SPSS Inc., Chicago, Illinois). Data regarding normality distribution of continuous variables was assessed with Kolmogorov-Smirnov or Shapiro-Wilk tests. Continuous and categorical variables were expressed as mean ± standard deviation and percentages, respectively. Student’s t test was used to compare the continuous variables and the categorical variables were compared with the chi-square test or Fisher’s exact test. Multivariate logistic regression analysis was performed to determine the independent predictors of non-dipping BP pattern. All variables with p