Abstract
This study aimed to describe the epidemiology of repolarization dispersion (QT dispersion and Tpeak-Tend dispersion) and further describe their associated clinical correlates among uncontrolled arterial hypertension in type-2 Diabetics patient, in western region of the Republic of Macedonia. Abnormal ventricular repolarization is associated with increased cardiovascular risk. Data relating to the frequency of increased repolarization dispersion, among uncontrolled arterial hypertension in type-2 Diabetics patient in western region of the Republic of Macedonia, are scarce. A total of 600 patients were enrolled into this observation study. Study participans were selected among primary care patient, who were receiving ongoing care for diabetes mellitus and hypertension during 1 calendar year. Twelve lead resting electrocardiography, QT, QTc, Tpeak-Tend-intervals and dispersions, were determined manually, and were compared between groups. Patients with uncontrolled BP have greater frequency of: prolonged QTc.max.interval, (61.3% vs.33.6%; p = 0.0005), prolonged Tpeak-Tend interval (65.3% vs. 34.7%; p = 0.005), increased dispersion of QTc. interval (65.9% vs. 34.1%; p = 0.00), increased disperion of Tpeak-Tend interval (65.5% vs. 34.5%; p = 0.002). Females with uncontrolled BP have greater frequency of: increased dispersion of QTc. interval (61.2% vs. 38%; p = 0.02), increased dispersion of Tpeak-Tend interval (63.1% vs. 31.5%; p = 0.008). Hypertensive diabetic patients with uncontrolled BP and abnormal ventricular repolarization have greater BMI (p = 0.000; 95%CI 3.849 - 7.871), longer duration of D.M (p = 0.000; 95%CI 1.600 - 1.981), longer duration of arterial hypertension (p = 0.000; 95%CI 1.468 - 1.850) and less controlled glycemia (p = 0.000; 95%CI 1.556 - 3.004). Frequency of increased set of electrophysiological parameters that indicate a prolonged and more heterogeneous repolarization among diabetic patients with uncontrolled BP, is considerable high and seems to be significantly associated with demographic and clinical parameters: gender, BMI, duration of diabetes, duration of BP and glycemic control.
Highlights
Systematic arterial hypertension and diabetes mellitus type-2, are both common chronic contitions that frequently coexist
Hypertensive diabetic patients with uncontrolled blood pressure (BP) and abnormal ventricular repolarization have greater body mass index (BMI) (p = 0.000; 95%CI 3.849 - 7.871), longer duration of D.M (p = 0.000; 95%CI 1.600 - 1.981), longer duration of arterial hypertension (p = 0.000; 95%CI 1.468 - 1.850) and less controlled glycemia (p = 0.000; 95%CI 1.556 - 3.004)
A small percentage (37.5%) of hypertensive diabetic patients, had their blood pressure control according to evidence and current guidelines, while a high percentage (62.5%) of hypertensive diabetic patients, have uncontrolled their blood pressure, despite ongoing medical treatment.The difference was found to be statistically significant (Chi-square = 26.5; p = 0.000)
Summary
Systematic arterial hypertension and diabetes mellitus type-2, are both common chronic contitions that frequently coexist. Patients with both disorders have a markely higher risk for cardiovascular complication [1]-[4]. Blood pressure is poorly controlled in most European countries and the control rate is even lower in high-risk patient such as diabetic patients [7]-[10]. There is evidence that the arrhythmic and sudden cardiac death risk in hypertension increase with rises in blood pressure [4]. QT-dispersion that reflects spatial inhomogeneity of ventricular repolarization and Tpeak-Tend dispersion that reflects transmural inhomogeneity of ventricular repolarization, are associated with increased risk of certain arrhythmias and sudden cardiac death in type 2 diabetic patients [11]-[13]
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