Effect of four classes of antihypertensive drugs on cardiac repolarization heterogeneity: A double-blind rotational study.

Heini Sánez Tähtisalo,Kimmo Porthan,Juha Virolainen,Tuomas Kenttä,Kimmo K Kontula,Timo P Hiltunen,Lasse Oikarinen,Juhani Junttila

doi:10.1371/journal.pone.0230655

Heini Sánez Tähtisalo, Kimmo Porthan + Show 6 more

Open Access

PDF Available

https://doi.org/10.1371/journal.pone.0230655

Copy DOI

Export

Save

Cite

Abstract
Highlights/Summary
Full-Text PDF
Similar Papers

Abstract

Listen

BackgroundT-wave area dispersion (TW-Ad) is a novel electrocardiographic (ECG) repolarization marker associated with sudden cardiac death. However, limited data is available on the clinical correlates of TW-Ad. In addition, there are no previous studies on cardiovascular drug effects on TW-Ad. In this study, we examined the relation between TW-Ad and left ventricular mass. We also studied the effects of four commonly used antihypertensive drugs on TW-Ad.MethodsA total of 242 moderately hypertensive males (age, 51±6 years; office systolic/diastolic blood pressure during placebo, 153±14/100±8 mmHg), participating in the GENRES study, were included. Left ventricular mass index was determined by transthoracic echocardiography. Antihypertensive four-week monotherapies (a diuretic, a beta-blocker, a calcium channel blocker, and an angiotensin receptor antagonist) were administered in a randomized rotational fashion. Four-week placebo periods preceded all monotherapies. The average value of measurements (over 1700 ECGs in total) from all available placebo periods served as a reference to which measurements during each drug period were compared.ResultsLower, i.e. risk-associated TW-Ad values correlated with a higher left ventricular mass index (r = −0.14, p = 0.03). Bisoprolol, a beta-blocker, elicited a positive change in TW-Ad (p = 1.9×10−5), but the three other drugs had no significant effect on TW-Ad.ConclusionsOur results show that TW-Ad is correlated with left ventricular mass and can be modified favorably by the use of bisoprolol, although demonstration of any effects on clinical endpoints requires long-term prospective studies. Altogether, our results suggest that TW-Ad is an ECG repolarization measure of left ventricular arrhythmogenic substrate.

Highlights

Despite recent great progress in cardiovascular disease prevention, sudden cardiac death (SCD) remains a major contributor to mortality, accounting globally for 1.5 million deaths yearly [1]
T-wave area dispersion (TW-Ad) is a novel electrocardiographic (ECG) repolarization marker associated with sudden cardiac death
I.e. risk-associated TW-Ad values correlated with a higher left ventricular mass index (r = −0.14, p = 0.03)

Summary

Introduction

Despite recent great progress in cardiovascular disease prevention, sudden cardiac death (SCD) remains a major contributor to mortality, accounting globally for 1.5 million deaths yearly [1]. Due to the major impact of SCD at the population level, a number of predictive risk stratification techniques have been proposed, including analyses of autonomic nervous system function, cardiac imaging, molecular genetic assays as well as electrocardiographic (ECG) analyses [2,3,4] but none has proven to fully satisfy requirements for population screening. T-wave area dispersion (TW-Ad) is a novel electrocardiographic (ECG) repolarization marker associated with sudden cardiac death. Limited data is available on the clinical correlates of TW-Ad. In addition, there are no previous studies on cardiovascular drug effects on TW-Ad. In this study, we examined the relation between TW-Ad and left ventricular mass. We studied the effects of four commonly used antihypertensive drugs on TWAd.

Methods

Results

Conclusion