Effect of telmisartan on QT interval variability and autonomic control in hypertensive patients with left ventricular hypertrophy.
OBJECTIVE
The aim of the study was to examine the effect of the antihypertensive AT1 receptors antagonist telmisartan on cardiovascular autonomic function and QT dispersion in hypertensive patients with LVH.


METHODS
Twenty-five patients (18 males and seven women, mean age 49.8±5.2 years) with mild essential arterial hypertension and LVH were compared with 25 age-matched healthy controls. All the participants underwent a complete clinical examination, including electrocardiogram for QT interval measurements and 24h ambulatory ECG monitoring for measurement of heart rate variability. The ECG, 24h ambulatory ECG, and echocardiogram were repeated after eight weeks of treatment.


RESULTS
At baseline, hypertensive patients showed QT dispersion (p<0.001) and QTc dispersion (p<0.001) significantly higher than control subjects. An eight-week telmisartan treatment significantly reduced blood pressure (p<0.0001), without significant change in left ventricular mass. Telmisartan-based treatment induced an increased vagal activity without significant change of sympathetic activity and a reduction of QT dispersion (p<0.001) and QTc dispersion (p<0.001).


CONCLUSIONS
These data suggest that therapy with telmisartan significantly improves the sympathovagal balance increasing parasympathetic activity, and cardiac electrical stability reducing the heterogeneity of ventricular repolarization in hypertensive subjects. These effects could contribute to reduce arrhythmias as well as sudden cardiac death in at-risk hypertensive patients.
Galetta
Fabio
F
Department of Internal Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy. fgaletta@med.unipi.it
Franzoni
Ferdinando
F
Fallahi
Poupak
P
Tocchini
Leonardo
L
Graci
Francesca
F
Carpi
Angelo
A
Antonelli
Alessandro
A
Santoro
Gino
G
D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D001341:Autonomic Nervous System / Q000187:drug effects* / Q000503:physiopathology; D001562:Benzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D001565:Benzoates / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D002319:Cardiovascular System / Q000187:drug effects / Q000294:innervation; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010275:Parasympathetic Nervous System / Q000187:drug effects; D000077333:Telmisartan; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001565:Benzoates; D000077333:Telmisartan