Heart rate turbulence measurements in patients with dipper and non-dipper hypertension: the effects of autonomic functions
Heart rate turbulence measurements in patients with dipper and non-dipper hypertension: the effects of autonomic functions
Background/aim: Hypertensive patients have shown autonomic dysfunction that is closely associated with the measurements of heart rate variability (HRV) and heart rate turbulence (HRT). We aimed to show the alterations of HRV and HRT measurements in patients with both dipper and non-dipper hypertension. Materials and methods: This was a retrospective study consisting of one hundred and twenty-three participants (mean age ± SD, 55.7 ± 14.8 years; range, 18–90 years). The participants were divided into two groups: Group1: The patients with dipper hypertension, Group2: The patients with non-dipper hypertension. Two cardiologists performed HRV and HRT using 24-h electrocardiography (ECG) Holter and ambulatory blood pressure monitoring (ABPM) of patients. Results: The results indicated that patients in group 2 had higher low frequency power/high frequency power ratio (LF/HF), lower high frequency power (HF) , root mean square of standard deviation (RMSSD) values than group 1 (p = 0.007, p = 0.008, and p = 0.002, respectively). Group 2 also showed higher heart rate turbulence onset (HRTTO) and lower heart rate turbulence slope (HRTTS) values than Group 1 (p = 0.004, p = 0.001, respectively). We performed multivariate analysis and observed that HRTTS and HRTTO have statistically significant associations with the presence of dipper or non-dipper hypertension [F = 7.755, p = 0.001], LF/HF [F = 7.868, p = 0.001], and HF [F = 4.081, p = 0.020]. Conclusion: This study shows a statistically significant difference in HRT measurements between dipper and non-dipper hypertensive patients. Deteriorated autonomic circadian rhythm and autonomic functions may contribute to these results.Key words: Electrocardiography, ambulatory blood pressure, heart rate, hypertension, autonomic nervous system
___
- 1. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, Selected major risk factors and global and regional burden of disease. Lancet 2002; 360(9343): 1347-1360. Doi: 10.1016/ S0140-6736(02)11403-6
- 2. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal 2013; 34(28): 2159-2219. Doi: 10.1093/eurheartj/ eht151
- 3. Routledge FS, McFetridge-Durdle JA, Dean CR, Canadian Hypertension S. Night-time blood pressure patterns and target organ damage: a review. The Canadian Journal of Cardiology 2007; 23(2): 132-138. doi.org/10.1016/S0828- 282X(07)70733-X
- 4. Seo WS, Oh HS. The circadian rhythms of blood pressure and heart rate in the hypertensive subjects: dippers and nondippers. Yonsei Medical Journal 2002; 43(3): 320-328. Doi: 10.3349/ymj.2002.43.3.320
- 5. Myredal A, Friberg P, Johansson M. Elevated myocardial repolarization lability and arterial baroreflex dysfunction in healthy individuals with nondipping blood pressure pattern. American Journal of Hypertension 2010; 23(3): 255-259. Doi: 10.1038/ajh.2009.252
- 6. Shen MJ, Zipes DP. Role of the autonomic nervous system in modulating cardiac arrhythmias. Circulation Research 2014; 114(6): 1004-1021. Doi: 10.1161/CIRCRESAHA.113.302549
- 7. Francis J, Watanabe MA, Schmidt G. Heart rate turbulence: a new predictor for risk of sudden cardiac death. Annals of Noninvasive Electrocardiology 2005; 10(1): 102-109. Doi: 10.1111/j.1542-474X.2005.10102.x
- 8. Report S. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93(5): 1043-1065. doi.org/10.1161/01.CIR.93.5.1043
- 9. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International Journal of Cardiology 2010; 141(2): 122-131. Doi: 10.1016/j.ijcard.2009.09.543
- 10. Passino C, Magagna A, Conforti F, Buralli S, Kozakova M et al. Ventricular repolarization is prolonged in non-dipper hypertensive patients: role of left ventricular hypertrophy and autonomic dysfunction. Journal of Hypertension 2003; 21(2): 445-451. Doi: 10.1097/00004872-200302000-00038
- 11. Liu M, Takahashi H, Morita Y, Maruyama S, Mizuno M et al. Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients. Nephrology, Dialysis, Transplantation 2003; 18(3): 563-569. doi.org/10.1093/ndt/18.3.563
- 12. Disertori M, Mase M, Rigoni M, Nollo G, Ravelli F. Heart Rate Turbulence Is a Powerful Predictor of Cardiac Death and Ventricular Arrhythmias in Postmyocardial Infarction and Heart Failure Patients: A Systematic Review and MetaAnalysis. Circulation. Arrhythmia and Electrophysiology 2016; 9(12). Doi: 10.1161/CIRCEP.116.004610
- 13. Watanabe MA. Heart rate turbulence: a review. Indian Pacing and Electrophysiology Journal 2003; 3(1): 10-22. PubMed PMID: 16943986
- 14. Balcioglu AS, Akinci S, Cicek D, Coner A, Bal UA et al. Cardiac autonomic nervous dysfunction detected by both heart rate variability and heart rate turbulence in prediabetic patients with isolated impaired fasting glucose. Anatolian Journal of Cardiology 2016; 16(10): 762-769. Doi: 10.14744/ AnatolJCardiol.2015.6654
- 15. Watanabe MA, Schmidt G. Heart rate turbulence: a 5-year review. Heart Rhythm 2004; 1(6): 732-738. Doi: 10.1016/j. hrthm.2004.09.003
- 16. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of The American Society of Echocardiography 2019 Jan;32(1):1- 64. Doi: 10.1016/j.echo.2018.06.004
- 17. Viera AJ, Shimbo D. Ambulatory blood pressure phenotypes and the risk for hypertension. Current Hypertension Reports 2014; 16(10): 481. Doi: 10.1007/s11906-014-0481-5
- 18. Najafi MT, Khaloo P, Alemi H, Jaafarinia A, Blaha MJ et al. Ambulatory blood pressure monitoring and diabetes complications: Targeting morning blood pressure surge and nocturnal dipping. Medicine 2018; 97(38): e12185. Doi: 10.1097/MD.0000000000012185
- 19. Campbell PT, White WB. Utility of ambulatory blood pressure monitoring for the management of hypertension. Current Opinion in Cardiology 2017; 32(4): 365-372. Doi: 10.1097/ HCO.0000000000000399
- 20. Sherwood A, Hill LK, Blumenthal JA, Hinderliter AL. Circadian hemodynamics in men and women with high blood pressure: dipper vs. non-dipper and racial differences. Journal of Hypertension 2018; 36(2): 250-258. Doi: 10.1097/ H01533JH.00000000000
- 21. Askin L, Tasolar H, Aksu U, Cetin M, Uslu A et al. Discerning the relationship between left ventricular geometry, highsensitivity troponin T, and non-dipper hypertension. Blood Pressure Monitoring 2018; 23(1): 12-18. Doi: 10.1097/ MBP.0000000000000297
- 22. Presta V, Figliuzzi I, D’Agostino M, Citoni B, Miceli F et al. Nocturnal blood pressure patterns and cardiovascular outcomes in patients with masked hypertension. Journal of Clinical Hypertension 2018; 20(9): 1238-1246. Doi: 10.1111/jch.13361
- 23. Pierdomenico SD, Pierdomenico AM, Di Tommaso R, Coccina F, Di Carlo S et al. Morning Blood Pressure Surge, Dipping, and Risk of Coronary Events in Elderly Treated Hypertensive Patients. American Journal of Hypertension 2016; 29(1): 39-45. Doi: 10.1093/ajh/hpv074
- 24. Kalaycioglu E, Gokdeniz T, Aykan AC, Gul I, Ugur M et al. The influence of dipper/non-dipper blood pressure patterns on global left ventricular systolic function in hypertensive diabetic patients: a speckle tracking study. Blood Pressure Monitoring 2014; 19(5): 263-270. Doi: 10.1097/MBP.0000000000000055
- 25. Pierdomenico SD, Pierdomenico AM, Cuccurullo F. Morning blood pressure surge, dipping, and risk of ischemic stroke in elderly patients treated for hypertension. American Journal of Hypertension 2014; 27(4): 564-570. Doi: 10.1093/ajh/hpt170
- 26. Cuspidi C, Facchetti R, Quarti-Trevano F, Dell’Oro R, Tadic M et al. Clinical correlates and subclinical cardiac organ damage in different extreme dipping patterns. Journal of Hypertension 2020; 38(5): 858-863. Doi: 10.1097/HJH.0000000000002351
- 27. Crinion SJ, Ryan S, McNicholas WT. Obstructive sleep apnoea as a cause of nocturnal nondipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms. The European Respiratory Journal 2017; 49(1):1601818 Doi: 10.1183/13993003.01818-2016
- 28. O’Flynn AM, Madden JM, Russell AJ, Curtin RJ, Kearney PM. Isolated nocturnal hypertension and subclinical target organ damage: a systematic review of the literature. Hypertension Research 2015; 38(8): 570-575. Doi: 10.1038/hr.2015.43
- 29. Pierdomenico SD, Lapenna D, Cuccurullo F. Risk of atrial fibrillation in dipper and non-dipper sustained hypertensive patients. Blood Pressure Monitoring 2008; 13(4): 193-197. Doi: 10.1097/MBP.0b013e3282feea70
- 30. Ijiri H, Kohno I, Yin D, Iwasaki H, Takusagawa M et al. Cardiac arrhythmias and left ventricular hypertrophy in dipper and nondipper patients with essential hypertension. Japanese Circulation Journal 2000; 64(7): 499-504. Doi: 10.1253/jcj.64.499
- 31. Rizzo V, Maio FD, Campbell SV, Tallarico D, Petretto F et al. Left ventricular function, cardiac dysrhythmias, atrial activation, and volumes in non-dipper hypertensive individuals with left ventricular hypertrophy. American Heart Journal 2000; 139(3): 529-536. Doi: 10.1016/s0002-8703(00)90098-x
- 32. Kario K, Motai K, Mitsuhashi T, Suzuki T, Nakagawa Y et al. Autonomic nervous system dysfunction in elderly hypertensive patients with abnormal diurnal blood pressure variation: relation to silent cerebrovascular disease. Hypertension 1997; 30(6): 1504-1510. Doi: 10.1161/01.hyp.30.6.1504
- 33. McGregor DO, Olsson C, Lynn KL. Autonomic dysfunction and ambulatory blood pressure in renal transplant recipients. Transplantation 2001; 71(9): 1277-1281. Doi: 10.1097/00007890-200105150-00016
- 34. Schillaci G, Verdecchia P, Borgioni C, Ciucci A, Zampi I et al. Association between persistent pressure overload and ventricular arrhythmias in essential hypertension. Hypertension 1996; 28(2): 284-289. Doi: 10.1161/01. hyp.28.2.284
- 35. Yu Y, Xu Y, Zhang M, Wang Y, Zou W et al. Value of Assessing Autonomic Nervous Function by Heart Rate Variability and Heart Rate Turbulence in Hypertensive Patients. International Journal of Hypertension 2018; 2018: 4067601. Doi: 10.1155/2018/4067601
- 36. Silvani A. Sleep disorders, nocturnal blood pressure, and cardiovascular risk: A translational perspective. Autonomic Neuroscience 2019; 218: 31-42. Doi: 10.1016/j. autneu.2019.02.006
- 37. Mongkhonsiri P, Tong-Un T, Wyss JM, Roysommuti S. Blunted Nighttime Sympathetic Nervous System Response to Stress Among Thai Men with Positive Family History of Sudden Unexplained Nocturnal Death Syndrome. International Heart Journal 2019; 60(1): 55-62. Doi: 10.1536/ihj.18-061
- 38. Eguchi K, Hoshide S, Ishikawa J, Pickering TG, Schwartz JE et al. Nocturnal nondipping of heart rate predicts cardiovascular events in hypertensive patients. Journal of Hypertension 2009; 27(11): 2265-2270. Doi: 10.1097/HJH.0b013e328330a938
- 39. Erdem A, Dogan OT, Yontar OC, Epozturk K, Ozlu MF et al. The pure effects of obstructive sleep apnea syndrome on cardiac autonomic functions: heart rate turbulence analysis. European Review for Medical and Pharmacological Sciences 2013; 17(20): 2778-2783. PMID: 24174360