Elevated myocardial repolarization lability and arterial baroreflex dysfunction in healthy individuals with nondipping blood pressure pattern.
BACKGROUND
The "nondipping" pattern (NDP) of blood pressure, characterized by the absence of the reduction in blood pressure (BP) that typically takes place during the night time, has been associated with elevated cardiovascular morbidity, including stroke, myocardial infarction, and sudden cardiac-related death. In various cardiovascular diseases, reduced vagal control of cardiac function and elevated lability of cardiac repolarization have been associated with increased risk for ventricular arrhythmia and sudden death. The aim of this study was to assess temporal QT variability, arterial baroreflex sensitivity (BRS), and baroreflex effectiveness index (BEI) in two groups of otherwise healthy subjects, one group consisting of those with a normal BP pattern and the other with a nondipping BP pattern.


METHODS
Ninety-five healthy subjects underwent 24-h ambulatory BP (AMBP) monitoring. A minimum of 10% reduction in BP during the night relative to daytime levels is considered normal (as found in "dippers"). These individuals were classified as "dippers" (n = 59) and individuals without 10% reduction in BP during night were classified as "nondippers" (n = 36). Electrocardiogram (ECG) readings and beat-to-beat BP were recorded at 1,000 Hz with the subjects at rest in the supine posture for 20 min. BRS, BEI, and QT variability index (QTVI) were calculated.


RESULTS
There were no differences between the study groups with respect to age, gender, and average BP. Nondippers showed an increase in QTVI (-1.28 +/- 0.48 in nondippers vs. -1.52 +/- 0.29 in dippers, P < 0.05) and a decrease in BEI (0.34 +/- 0.17 in nondippers vs. 0.43 +/- 0.17 in dippers, P < 0.05), whereas BRS did not differ between the groups.


CONCLUSIONS
A nondipping BP pattern in healthy subjects is associated with elevated myocardial repolarization lability and impaired baroreflex function, suggesting dysfunction of the autonomic nervous system.
Myredal
Anna
A
Department of Internal Medicine, Varberg Hospital, Varberg, Sweden. anna.myredal@lthalland.se
Friberg
Peter
P
Johansson
Mats
M
D000368:Aged; D001158:Arteries / Q000294:innervation / Q000502:physiology / Q000503:physiopathology*; D001341:Autonomic Nervous System / Q000503:physiopathology; D017704:Baroreflex; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D005260:Female; D006321:Heart / Q000294:innervation / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009206:Myocardium