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Fragmented QRS as a predictor of hypertensive crisis in patients with newly diagnosed essential hypertension: 4-year follow-up data

Fragmentierter QRS-Komplex als Prädiktor einer hypertensiven Krise bei Patienten mit neu diagnostizierter essenzieller Hypertonie: 4‑Jahres-Follow-up-Daten

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Abstract

Background

Hypertensive crisis (HC) is a life-threatening condition in patients with hypertension (HT). However, there is no electrocardiography (ECG) marker that can predict which hypertensive patient may develop HC. The fragmented QRS (fQRS) complex is an important prognostic marker in ECG that might be predict cardiovascular events and mortality. Our study aimed to investigate whether fQRS can predict the development of HC in patients with HT, within 4 years of follow-up.

Methods

Newly diagnosed patients with essential HT were recruited for the study from an outpatient clinic. The patients were divided into two groups according to the presence of HC: HC (+) and HC (−). During follow-up, the relationship between fQRS and HC was evaluated.

Results

The study group included 504 patients with newly diagnosed HT. During the follow-up period, HC occurred in 98 of the patients. In 57 (11.30%) patients, fQRS was observed on ECG; fQRS was detected in the ECG of 19 (19.38%) of the HC (+) patients (p = 0.008). The results of multivariate logistic regression analysis showed that fQRS (p < 0.001) was as independent predictor for HC development. Kaplan–Meier analysis further demonstrated that the presence of fQRS affects the development of hypertensive urgency in hypertensive patients (log-rank p < 0.001).

Conclusion

In patients with newly diagnosed HT, the presence of fQRS was found to be an independent predictor of HC.

Zusammenfassung

Hintergrund

Die hypertensive Krise (HC) stellt eine lebensbedrohende Situation bei Patienten mit Hypertonie (HT) dar. Jedoch gibt es keine Elektrokardiogramm(EKG)-Marker, anhand derer die Vorhersage möglich ist, welcher Patient möglicherweise eine HC entwickelt. Der fragmentierte QRS-Komplex (fQRS) ist ein wichtiger prognostischer Marker im EKG, mit dem sich ggf. kardiovaskuläre Ereignisse und Mortalität vorhersagen lassen. Ziel der vorliegenden Studie war es zu untersuchen, ob sich anhand des fQRS die Entwicklung einer HC bei Patienten mit HT innerhalb eines 4‑Jahres-Follow-up vorhersagen lässt.

Methoden

Für die Studie wurden Patienten mit neu diagnostizierter essenzieller Hypertonie aus einer Ambulanz rekrutiert. Je nach Vorliegen einer HC wurden die Patienten in 2 Gruppen unterteilt: HC(+) und HC(−). Während des Follow-up wurde der Zusammenhang zwischen fQRS und HC untersucht.

Ergebnisse

Zur Studiengruppe gehörten 504 Patienten mit neu diagnostizierter HT. Während der Follow-up-Phase trat bei 98 der Patienten eine HC auf. Bei 57 (11,30 %) Patienten wurde ein fQRS im EKG festgestellt; dabei zeigte sich ein fQRS im EKG von 19 (19,38 %) der HC(+)-Patienten (p = 0,008). Die multivariate logistische Regressionsanalyse ergab, dass fQRS (p < 0,001) ein unabhängiger Prädiktor für das Auftreten einer HC war. Außerdem zeigte die Kaplan-Meier-Analyse, dass das Bestehen eines fQRS sich auf die Entstehung einer Situation mit hypertensiver Dringlichkeit bei Hypertoniepatienten auswirkt (log-rank-p < 0,001).

Schlussfolgerung

Bei Patienten mit neu diagnostizierter HT stellte sich das Vorliegen eines fQRS als unabhängiger Prädiktor einer HC heraus.

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Authors and Affiliations

  1. Department of Cardiology, Sancaktepe Sehit Professor Ilhan Varank Education and Research Hospital, Istanbul, Turkey

    Emine Altuntas MD & Sükrü Cetın Assist. Prof, MD

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  1. Emine Altuntas MD
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  2. Sükrü Cetın Assist. Prof, MD
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Correspondence to Emine Altuntas MD.

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E. Altuntas and S. Cetın declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Altuntas, E., Cetın, S. Fragmented QRS as a predictor of hypertensive crisis in patients with newly diagnosed essential hypertension: 4-year follow-up data. Herz 48, 474–479 (2023). https://doi.org/10.1007/s00059-023-05194-2

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  • DOI: https://doi.org/10.1007/s00059-023-05194-2

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