Hasan KORKMAZ, Orhan ÖNALAN, Mehmet AKBULUT, Ilgın KARACA, Yılmaz ÖZBAY, Kenan ERDEM

Hipertansif Hastalarda Kinapril ve Nebivolol’ün QT Dispersiyonu Üzerine Etkileri

Giriş: QT interval dispersiyonunun (QTD) ventrikül repolarizasyon inhomojenitesinin bir göstergesi olduğu düşünülmektedir. Bu çalışmada hipertansif hastalarda kısa süreli nebivolol ve kinapril tedavisinin QTD üzerine olan etkilerinin araştırılması amaçlandı. Gereç ve Yöntem: İlaç kullanmayan veya yeni tanı almış hipertansif hastalara sırasıyla kinapril veya nebivolol tedavisi başlandı. QT intervali yüzeyel EKG’de Q dalgasının başından T dalgasının sonuna kadar olan mesafe olarak ölçüldü ve değerler (QTC) Bazett formülü ile kalp hızına göre düzeltildi. Maximum ve minimum QT intervalleri arasındaki fark QTD olarak tanımlandı. Bulgular: Gruplar (Kinapril, n= 27, Nebivolol, n=27) demografik, ekokardiyografik, biyokimyasal ve klinik değişkenler bakımından benzerdi. Dört haftalık bir tedavi sonunda SKB (her iki grupta da p

Anahtar Kelimeler:

Kinapril, Nebivolol, QT dispersiyonu

In Hipertansion Patients Affects of Quinapril and Nebivolol on QT Dispersion

Objectives: QT dispersion (QTD) is thought to reflect spatial heterogeneity of ventricular refractoriness. We aimed to investigate and compare the effect of nebivolol and Quinapril on the QTD in patients with hypertension. Material and Methods: Patients with established or newly diagnosed hypertension were included. The QT interval was measured in all leads from a standard 12-lead ECG and QTD was defined as the difference between the maximum and minimum QT interval. The QTD values were corrected for heart rate using Bazett's formula (QTDC). Results: Groups (Quinapril, n= 27, Nebivolol, n=27) were similar with respect to demografic, echocardiographic, biochemichal and clinical variables. After four weeks of tretament a significant reduction was observed in systolic (p

Keywords:

-,

PDF

___

Glancy JM, Garratt CJ, Woods KL, de Bono DP. QT dispersion and mortality after myocardial infarction. Lancet 1995;345:945-8.
Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT dispersion and sudden unexpected death in chronic heart failure. Lancet 1994; 343: 327-9.
Batur MK, Acil T, Onalan O, et al. Is ventricular repolarization heterogeneity a cause of serious ventricular tachyarrhythmias in aortic valve stenosis? Clin Cardiol 2000; 23: 449-52.
Clarkson PB, Naas AA, McMahon A, MacLeod C, Struthers AD, MacDonald TM. QT dispersion in essential hypertension. Qjm 1995;88:327-32.
Buja G, Miorelli M, Turrini P, Melacini P, Nava A. Comparison of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol 1993;72:973-6.
Mayet J, Shahi M, McGrath K, et al. Left ventricular hypertrophy and QT dispersion in hypertension. Hypertension 1996;28:791-6.
Oikarinen L, Nieminen MS, Toivonen L, et al. Relation of QT interval and QT dispersion to regression of echocardiographic and electrocardiographic left ventricular hypertrophy in hypertensive patients: the Losartan Intervention For Endpoint Reduction (LIFE) study. Am Heart J 2003;145:919-25.
van Zwieten PA. The influence of antihypertensive drug treatment on the prevention and regression of left ventricular hypertrophy. Cardiovasc Res 2000;45:82-91.
Brilla CG. Regression of myocardial fibrosis in hypertensive heart disease: diverse effects of various antihypertensive drugs. Cardiovasc Res 2000;46:324-31.
Batur MK, Onalan O, Yildirir A, et al. Effects of blood pressure control on ventricular arrhythmias and related non-invasive electrocardiologic parameters in hypertensive patients. New Trends in Electrocardiology. 40128 Bologna: MONDUZZI EDITORE, 2000:167-177.
Galetta F, Franzoni F, Magagna A, et al. Effect of nebivolol on QT dispersion in hypertensive patients with left ventricular hypertrophy. Biomed Pharmacother 2005;59:15-9.
Gonzalez-Juanatey JR, Garcia-Acuna JM, Pose A, et al. Reduction of QT and QTc dispersion during long-term treatment of systemic hypertension with enalapril. Am J Cardiol 1998;81:170-4.
Karpanou EA, Vyssoulis GP, Psichogios A, et al. Regression of left ventricular hypertrophy results in improvement of QT dispersion in patients with hypertension. Am Heart J 1998;136:765-8.
Lim PO, Nys M, Naas AA, Struthers AD, Osbakken M, MacDonald TM. Irbesartan reduces QT dispersion in hypertensive individuals. Hypertension 1999;33:713-718.
Oikarinen L, Viitasalo M, Toivonen L, Nieminen MS. Comparative effects of atenolol-based and amlodipine-based antihypertensive therapy on QT dispersion in hypertensive subjects. J Hum Hypertens 2001;15 Suppl 1:S43-5.
Lu HR, Remeysen P, De Clerck F. Antiarrhythmic effects of nebivolol in experimental models in vivo. J Cardiovasc Pharmacol 1994;24:986-93. 17. Bazett HC. An analysis of the time-relations of
electrocardiograms. Heart 1920;7:353-370.
Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450-458.
2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011-1053.
Messerli FH. Hypertension and sudden cardiac death. Am J Hypertens 1999; 12: 181S-188S.
Messerli FH, Grodzicki T. Hypertension, left ventricular hypertrophy, ventricular arrhythmias and sudden death. Eur Heart J 1992;13 Suppl D:66-69.
Galinier M, Balanescu S, Fourcade J, et al. Prognostic value of ventricular arrhythmias in systemic hypertension. J Hypertens 1997;15:1779-1783.
Brooksby P, Robinson PJ, Segal R, Klinger G, Pitt B, Cowley AJ. Effects of losartan and captopril on QT dispersion in elderly patients with heart failure. ELITE study group. Lancet 1999;354:395-396.
De Mello WC. Cardiac arrhythmias: the possible role of the renin-angiotensin system. J Mol Med 2001;79:103-8.
Gavras I, Gavras H. The antiarrhythmic potential of angiotensin II antagonism: experience with losartan. Am J Hypertens 2000;13:512-7.
van den Meiracker AH, Boomsma F. The angiotensin II- sympathetic 2003;21:1453-4. connection. J Hypertens
Bonnar CE, Davie AP, Caruana L, et al. QT dispersion in patients with chronic heart failure: beta blockers are associated with a reduction in QT dispersion. Heart 1999;81:297-302.
Yildirir A, Sade E, Tokgozoglu L, Oto A. The effects of chronic carvedilol therapy on QT dispersion in patients with congestive heart failure. Eur J Heart Fail 2001;3:717-21.
Malmqvist K, Kahan T, Edner M, Bergfeldt L. Comparison of actions of irbesartan versus atenolol on cardiac repolarization in hypertensive left ventricular hypertrophy: results from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation Versus Atenolol (SILVHIA). Am J Cardiol 2002;90:1107-12.
Sule SS, Frishman W. Nebivolol: new therapy update. Cardiol Rev 2006;14:259-64.
Wisenbaugh T, Katz I, Davis J, et al. Long-term (3-month) effects of a new beta-blocker (nebivolol) on cardiac performance in dilated cardiomyopathy. J Am Coll Cardiol 1993;21:1094-100.
Erdogan D, Gullu H, Caliskan M, et al. Nebivolol Improves Coronary Flow Reserve in Patients with Idiopathic Dilated Cardiomyopathy. Heart 2006.
Oelze M, Daiber A, Brandes RP, et al. Nebivolol inhibits superoxide formation by NADPH oxidase and endothelial dysfunction in angiotensin II-treated rats. Hypertension 2006;48:677-684.
Franz MR, Bargheer K, Costard-Jackle A, Miller DC, Lichtlen PR. Human ventricular repolarization and T wave genesis. Prog Cardiovasc Dis 1991;33:369-384.
Janssen PM, Zeitz O, Hasenfuss G. Transient and sustained impacts of hydroxyl radicals on sarcoplasmic reticulum function: protective effects of nebivolol. Eur J Pharmacol 1999;366:223- 232.
Bonnar CE, MacFadyen RJ, Pringle SD, Struthers AD. QT- dispersion is related to sympathetic tone after acute myocardial infarction and in chronic heart failure. Journal of the American College of Cardiology 1998;31:132A-132A.
Perkiomaki JS, Huikuri HV, Koistinen JM, Makikallio T, Castellanos A, Myerburg RJ. Heart rate variability and dispersion of QT interval in patients with vulnerability to ventricular tachycardia and ventricular fibrillation after previous myocardial infarction. J Am Coll Cardiol 1997;30:1331-1338.
Roukema G, Singh JP, Meijs M, Carvalho C, Hart G. Effect of exercise-induced ischemia on QT interval dispersion. Am Heart J 1998;135:88-92.
Pagani M, Lucini D. Autonomic dysregulation in essential hypertension: insight from heart rate and arterial pressure variability. Auton Neurosci 2001;90:76-82.
Abildskov JA. Adrenergic effects of the QT interval of the electrocardiogram. Am Heart J 1976;92:210-216.
Kabul Tarihi: 12.12.2006