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(Hypertension. 2003;41:237.)
© 2003 American Heart Association, Inc.

Scientific Contributions

Morning Blood Pressure Peak, QT Intervals, and Sympathetic Activity in Hypertensive Patients

Raffaele Marfella; Pasquale Gualdiero; Mario Siniscalchi; Caterina Carusone; Mario Verza; Salvatore Marzano; Katherine Esposito; Dario Giugliano

From the Department of Geriatric and Metabolic Diseases, Second University of Naples, Naples Italy.

Correspondence to Dott Raffaele Marfella, Via Emilio Scaglione 141, 80145 Napoli, Italy. E-mail raffaele.marfella{at}unina2.it

We investigated the relation between morning blood pressure (BP) variations, sympathetic activity, and QT intervals in 156 never-treated subjects with essential hypertension and different patterns of morning BP increase. The morning BP peak (MP) was defined as a rise in systolic BP 50 mm Hg and/or diastolic BP 22 mm Hg during early morning (6:00 to 10:00 AM) compared with mean BP during the night. Clinical characteristics of patients with morning BP peak (MP+, n= 69, morning systolic BP=+54±4, diastolic BP=+32±5 mm Hg) did not differ from patients without BP peak (MP-, n= 87, morning systolic BP=+24±5, diastolic BP=+19±3 mm Hg). The daytime (10:00 AM to 10:00 PM) and the nighttime (10:00 PM to 6:00 AM) BP profile did not differ between the two groups. During daytime and nighttime ECG monitoring, the corrected QT (QTc) interval, and QTc dispersion did not differ significantly between the two groups, whereas during the morning period the QT values were significantly broader in the MP+ group compared with the MP- group (P0.001). Morning LF/HF ratio was significantly higher in MP+ patients than in MP- patients (P0.02). Both systolic and diastolic morning BP, in combination with ratio LF/HF power, were significant predictors of QTc dispersion (adjusted R²=0.59, P0.01) and QTc interval (adjusted R²=0.41, P0.01), whereas inclusion of physical activity and echocardiographic parameters did not add explanatory information. The prolongation of cardiac repolarization times and morning sympathetic overactivity coexist in hypertensive patients with morning BP peaks, and they might contribute to raised cardiovascular risk in these patients.

Key Words: hypertension, essential • blood pressure • sympathetic nervous system

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