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    Effect of dipping status on QRS morphology in patients with hypertension
    (2010) Erden, Ismail; Erden, Emine Cakcak; Özhan, Hakan; Yalçin, Subhan; Basar, Cengiz; Aydin, Mesut
    BACKGROUND: Prolongation of the QRS complex on the surface electrocardiogram (ECG) has been shown to be predictive of cardiovascular outcomes in selected populations. A 'nondipper' blood pressure (BP) profile is currently regarded as a risk factor in its own right for cardiovascular events and target organ damage. The predictive value of ECG parameters in hypertensives with nondipper profile has not been established. MethodS: A total of 750 consecutive patients with hypertension who had been evaluated with ambulatory BP monitoring were screened for this study. One hundred and thirty-six patients who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and nondipper patterns were detected and the maximum QRS duration (QRSd) measured on a 12-lead ECG was recorded. RESULTS: There were 70 nondipper and 66 dipper hypertensives. There was no significant difference between the two groups regarding the daytime systolic and diastolic mean BPs, number of medications taken, and the proportion of each class of antihypertensive medications. Other variables were similar between the two groups. QRSd was significantly higher in nondippers than dippers (P=0.006). Correlation analysis revealed that the systolic BP fall at night was inversely and significantly related with QRSd (r=-0.482, P<0.001). Regression analysis further showed that the systolic BP fall at night and age were independent correlates of QRSd. Conclusion: QRSd on the standard-surface 12-lead ECG was increased in patients with nondipper pattern and furthermore the systolic BP fall at night was independent correlate of QRSd in patients with hypertension. Copyright © 2010 Lippincott Williams & Wilkins.
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    Poor-quality sleep score is an independent predictor of nondipping hypertension
    (Lippincott Williams and Wilkins, 2010) Erden, Ismail; Erden, Emine Cakcak; Özhan, Hakan; Basar, Cengiz; Aydin, Mesut; Dumlu, Talha; Alemdar, Recai
    objective: We aimed to investigate whether there was any association between the nondipping status and sleep quality in relatively young patients with an initial diagnosis of hypertension. METHODS: One hundred and thirty-three consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients with a history of use of any antihypertensive medication were excluded. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI) survey, which has an established role in evaluating sleep disturbances. All patients underwent ambulatory blood pressure monitoring. RESULTS: There were 71 nondipper patients (mean age 44.3±5.3 years, 33 male/38 female) and 62 dipper hypertensive patients (mean age 43.3±6.3 years, 27 male/35 female). The PSQI scores, globally, were significantly higher in the nondippers compared with the dippers. It was noticed that all the components of the PSQI (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) were significantly higher in the nondippers. Correlation analysis showed that systolic blood pressure fall at night was inversely and significantly related with the PSQI (r=-0.46, P<0.001). Logistic regression analysis showed that the PSQI score is an independent determinant for nondipping hypertension (HT) {odds ratio=0.842 [95% confidence interval (CI)=0.748-0.947; P=0.004]}. CONCLUSION: We showed that poor sleep quality was related with a nondipping pattern, and furthermore, it was an independent predictor of nondipping in newly diagnosed stage 1 hypertensive patients. © Lippincott Williams & Wilkins.