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Giuseppe Schillaci, MD; Matteo Pirro, MD; Tiziana Ronti, MD; Fabio Gemelli, MD; Giacomo Pucci, MD; Salvatore Innocente, MD; Carlo Porcellati, MD; Elmo Mannarino, MD

Arch Intern Med. 2006;166:909-913.

Background  QT interval prolongation on the surface electrocardiogram (ECG) predicts cardiovascular complications in high-risk subjects, but its prognostic role in uncomplicated hypertension has been understudied.

Methods  For up to 13 years (average, 5.3 years), we followed up 2110 white patients with initially untreated essential hypertension (mean ± SD age, 49 ± 12 years; 55% men) without prevalent cardiovascular or renal disease who underwent 12-lead ECG before therapy. We excluded patients with ECG abnormalities including ischemia, necrosis, complete bundle branch block, atrial fibrillation, arrhythmias, and ventricular preexcitation.

Results  Heart rate–corrected QT interval (QTc) showed a weak but significant direct association with systolic blood pressure (r = 0.07; P<.001), diastolic blood pressure (r = 0.11; P<.001), and Cornell voltage (r = 0.06; P = .006). During follow-up, 84 patients developed new-onset ischemic heart disease (0.75 event per 100 patient-years). After adjustment (Cox model) for the effects of age, sex, diabetes mellitus, serum cholesterol level, serum creatinine level, smoking, left ventricular hypertrophy, and 24-hour systolic blood pressure, patients with a prolonged QTc (450 milliseconds in women and 440 milliseconds in men) had a nearly 2-fold increase in risks of coronary events (hazard ratio, 1.95; 95% confidence interval, 1.12-3.42; P = .02) and cardiovascular death (hazard ratio, 2.05; 95% confidence interval, 1.03-4.37; P = .04). Coronary heart disease risk was independently higher by 33% (95% confidence interval, +7% to +66%; P = .01) for each 32-millisecond increase in QTc.

Conclusions  Prolonged ventricular repolarization is a risk factor for ischemic heart disease and cardiovascular mortality in subjects with uncomplicated hypertension. Its prognostic significance adds to that of several traditional cardiovascular risk factors, including left ventricular hypertrophy.

Author Affiliations: Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia (Drs Schillaci, Pirro, Ronti, Gemelli, Pucci, Innocente, and Mannarino), and Department of Cardiology, Perugia General Hospital (Dr Porcellati), Perugia, Italy.

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RELATED LETTERS

Prolonged Ventricular Repolarization in Hypertension: Is It Heart Rate?
Christian Funck-Brentano and Beny Charbit
Arch Intern Med. 2006;166(19):2157.
EXTRACT | FULL TEXT  

Prolonged Ventricular Repolarization in Hypertension: Is It Heart Rate?—Reply
Giuseppe Schillaci, Matteo Pirro, Tiziana Ronti, Fabio Gemelli, Giacomo Pucci, Salvatore Innocente, and Elmo Mannarino
Arch Intern Med. 2006;166(19):2157-2158.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prolonged ventricular repolarization in hypertension: is it heart rate?
Funck-Brentano and Charbit
Arch Intern Med 2006;166:2157-2157.
FULL TEXT  

Prolonged Ventricular Repolarization in Hypertension: Is It Heart Rate?--Reply
Schillaci et al.
Arch Intern Med 2006;166:2157-2158.
FULL TEXT