Author + information
- Gurkan Acar1,
- Mehmet Akgungor1,
- Idris Ardic1,
- Imran Dirnak1,
- Murat Akkoyun1,
- Soner Olmez2 and
- Mustafa Saygın Deniz3
Preliminary evidence has suggested the role of inflammation in development and prognosis of cardiovascular diseases. Hypertension is strongly associated with chronic systemic inflammation. The total white blood cell count and its subtypes, such as neutrophil, lymphocyte, and neutrophil/ lymphocyte ratio (NLR), can be used as an indicator of systemic inflammation. Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with several cardiovascular diseases. However, there is limited data about the role of NLR in patients with hypertension and prehypertension. Recently, several studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tp-e) may correspond to the transmural dispersion of repolarization and that increased Tp-e interval and Tp-e/QT ratio are associated with malignant ventricular arrhythmias and cardiovascular mortality. However, this method has not been used to evaluate dispersion of repolarization in subjects with hypertension and prehypertension. Accordingly, the present study was designed to evaluate NLR, Tp-e interval and Tp-e/QT ratio subjects with hypertension and prehypertension.
Between September 2012 and April 2013, the hypertensive, prehypertensive and normotensive healthy subjects who were admitted to our outpatient clinic were evaluated. According to inclusion and exclusion criteria the overall study population consisted of 95 subjects: 28 healthy volunteers with normal blood pressure (BP) (group I), 35 subjects with prehypertension (group II), and 32 patients with new onset hypertension (group III). No patient had a recent history of an acute infection or an inflammatory disease. The NLR was calculated by dividing neutrophil count to lymphocyte count. These Tp-e interval and Tp-e/QT ratio were measured from a 12-lead electrocardiogram, and the Tp-e interval corrected for heart rate. These parameters were compared among groups.
Demographic, clinical, and electrocardiographic parameters of the groups are shown in Table 1. Whereas NLR was similar among groups (p>0.05), corrected Tp-e interval and and Tp-e/QT ratio were significantly increased in patients with hypertension when compared with controls and prehypertension subjects (p<0.05).
NLR, as an indicator of systemic inflammation, was similar in subjects with normotensives, prehypertension and hypertension. Tp-e interval and Tp-e/QT ratio were increased in hypertension patients with respect to normal subjects. These parameters were similar to controls in prehypertension stage. Our results may contribute to pathophysiological mechanisms of increased prevalence of ventricular arrhythmias and cardiovascular mortality risk by indicating increased ventricular repolarization heterogeneity in hypertension patients.
|Group I: Normotensive controls (n=28)||Group II: Prehypetension (n=35)||Group III: Hypertension (n=32)|
|Males / Females||10/18||13/22||13/19|
|Systolic BP (mmHg)||115.9±7.8||134.6±16.5 *||160.8±19.3 * #|
|Diastolic BP (mmHg)||71.2±6.9||81.4±9.1 *||94.2±8.2 * #|
|Heart rate (beats/min)||75.3±11.1||78.9±12.4||79.5±12.3|
|LV EDD (mm)||46.3±3.4||47.1±3.7||48.2±3.0|
|LV EF (%)||66.2±2.8||66.5±2.8||65.9±2.6|
|LA dimension (mm)||33.9±3.5||33.8±3.4||36.5±3.1 ¥|
|Fasting glucose (mg/dl)||90.9±6.4||93.4±6.8||94.5±8.3|
|Mean platelet volume (fL)||8.0±0.61||8.3±0.77||8.1±0.70|
|cQTd (ms)||34.3±11.0||33.4±9.1||47.8±16.2 * #|
|cTp-e (ms)||95.6±14.3||98.0±11.6||107.0±10.7 @ $|
|Tp-e/QT||0.22±0.03||0.22±0.03||0.25±0.03 & ^|
*: p<0.001 vs group I, #: p<0.001 vs group II, ¥: p=0.02 vs group I and group II, @: p=0.002 vs group I, $: p=0.01 vs group II, &: p=0.004 vs group I, ^:p=0.003 vs group II BMI: body mass index, BP: blood pressure, LVEDD: left ventricular end-diastolic dimension, LV EF: left ventricular ejection fraction, LA: left atrium, WBC: white blood count, N/L ratio: Neutrophils to lymphocytes ratio, CRP: C-reactive protein, cQTd: corrected QT dispersion, cTp-e corrected transmural dispersion of repolarization.