Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients

Abstract

BackgroundFragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients.ObjectivesThe aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients.MethodsTwo hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients.ResultsAccording to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936).ConclusionsWe found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.

Subclinical cardiac structural and electrical abnormalities in fibromyalgia syndrome

“…Previous studies have reported that fQRS may be a sign of chronic and continuous pressure overload, especially due to increased systolic blood pressure that leads to pathological fibrosis in the presence or even absence of left ventricular hypertrophy. Additionally, increased interventricular septal thickness and left atrial diameter in FMS patients may also be related to the presence of fQRS in accordance with previous studies [38,39].…”

Highlights in the association of fragmented QRS with myocardial fibrosis

“…The association of fQRS with LVH in patients without hypertension has been previously reported [3]. Moreover, presence of fQRS on ECG also significantly predicts myocardial fibrosis and subclinical myocardial damage in patients without evidence of LVH and CVD [4][5][6][7]. In this sense, fQRS is generally considered as a sign of early stage myocardial fibrosis before the emergence of manifest CVD.…”

Fragmented QRS and blood pressure pattern in normotensive individuals with a history of preeclampsia

“…Fragmented QRS is an indicator of ventricular conduction caused by myocardial scarring, ischemia, or fibrosis [14]. Eyuboglu et al [15] reported that fQRS could be associated with impaired circadian BP changes in prehypertensive patients. The fQRS is more common in hypertensive patients compared to normotensives.…”