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AFRICA
211
18. Kabir AA, Whelton PK, Khan MM
et al
., Association of symptoms of
depression and obesity with hypertension: the Bogalusa Heart study.
Am
J Hypertens
2005;
19
(6): 639–645.
19. Schutte R, Schutte AE, Huisman HW, van Rooyen JM, Malan NT, Péter
S,
et al
. Blood glutathione and sub-clinical atherosclerosis in African
men: the SABPA study.
Am J Hypertens
2009;
22
: 1154–1159.
20. Giuseppe M, De Backer G, Dominiczak A,
et al
. 2007 Guidelines for the
management of arterial hypertension.
Eur Heart J
2007;
28
: 1462–1532.
21. World Medical Association. Declaration of Helsinki: Ethical princi-
ples for medical research involving human subjects. World Medical
Association online 2005 Available at:
/
b3.htm. Accessed November 9, 2008.
22. Obrist PA.
Cardiovascular Psychophysiology: A Perspective
. London:
Plenum Press, 1981.
23. World Health Organization 2003. The Global Physical Activity Ques-
tionnaire (GPAQ). Available at:
/
resources/GPAQ.htm Accessed: November 7, 2008.
24. Jackson G. The General Health questionnaire.
Occup Med
2007;
57
(1):
79.
25. Stapelberg R.
Psychometric characteristics of the Cope and SACS
in the Setswana-speaking South African group
(MA). Potchefstroom
University, Potchefstroom. 1999: 200.
26. Goldberg DP, Gater R, Sartorius TB,
et al.
The validity of two of the
GHQ in the WHO study of mental illness in general health care.
Psychol
Med
1997;
27
: 191–197.
27. Marfell-Jones M, Olds T, Stewart A,
et al
. International standards
for anthropometric assessment. ISAK: International Society for the
Advancement of Kinanthropometry, 2006: 58–87.
28. American College of Sports Medicine (ACSM).
Guidelines for Exercise
Testing and Prescription
. 7th edn. Philadelphia: Lippincott Williams &
Wilkins, 2006.
29. Heil DP. Predicting activity energy expenditure using the Actical
®
Activity Monitor.
Res Q Exercise Sport
2006;
77
(1): 64–80.
30. Ang DSC, Lang CC. The prognostic value of the ECG in hypertension:
where are you now?
J Hum Hypertens
2008;
22
: 460–467.
31. Riolo SA, Nguyen TA, Greden JF,
et al
. Prevalence of depression
by race/ethnicity: findings from the National Health & Nutrition
Examination study III.
Am J Public Hlth
2005;
95
(6): 998–1000.
32. Brownhill S, Wilhelm K, Barclay L,
et al.
‘Big build’: hidden depression
in men.
Aust N Z J Psychiat
2005;
39
(10): 921–931.
33. Appels A. Mental precursors of myocardial infarction.
Br J Psychiat
1990;
156
: 465–471.
34. Verdecchia P, Schillaci G, Borgioni C,
et al
. Prognostic values of a new
electrocardiographic method for the diagnosis of left ventricular hyper-
trophy in essential hypertension.
J Am Coll Cardiol
1998;
31
: 383–390.
35. Sundström J, Lind L, Arnlöv J,
et al
. Echocardiographic and echocar-
diographic diagnoses of left ventricular hypertrophy predict mortality
independently of each other in a population of elderly men.
Circulation
2001;
10
3: 2346–2351.
36. Farmer A. Medical disorders in people with recurrent depression.
Br J
Psychol
2008;
192
: 351–355.
37. Remme WJ. The sympathetic nervous system and ischemic heart
disease.
Eur Heart J
1998;
19
(F): 62–71.
38. Reynolds RM, Walker BR, Syddall HE,
et al.
Altered control of cortisol
levels and impaired cognition in human aging: implication for depres-
sion and dementia in later life.
Rev Neurosci
1999;
10
: 117–139.
39. Gold SM, Dziobek I, Rogers K. Hypertension and hypothalamo-
pituitary-adrenal axis hyperactivity affect frontal lobe integrity.
J Clin
Endocrinol Metab
2005;
90
(6): 3262–3267.
40. Rieff M, Schwartz S, Northridge M. Relationship of depressive symp-
toms to hypertension in a household survey in Harlem.
Psychosom Med
2001;
63
: 711–721.
41. Dimsdale JE. Symptoms of anxiety and depression as a precursor to
hypertension.
J Am Med Assoc
1997;
277
: 574–575.
42. Jonas BS, Frank P, Ingram DD. Are symptoms of anxiety and depression
risk factors for hypertension?
Arch Fam Med
1997;
6
(1): 43–49.
Letter to the Editor
Dear Sir
In their article on long-term outcome associated with early repo-
larisation on electrocardiography, Tikkanen and colleagues (
N
Engl J Med
2009, 24 December)
1
refer to the generally admitted
definition,
2,3
showing a figure with both slurring and notch-
ing patterns in subjects who died from arrhythmia. This is the
longest-ever published follow-up study on the topic.
It would be useful to have data on the prognostic significance
of each type of repolarisation. In our yet-to-be published regis-
try,
4
J-point elevation that was notched rather than a slurred vari-
ant appears to be strongly related to the history of transient loss
of consciousness in black Africans. However, this finding needs
to be studied prospectively.
In addition to the findings that inferior lead localisations and
the magnitude of the J-point elevation
≥
0.1 mV (mostly
>
0.2
mV) are stronger predictors of death from cardiac causes or
arrhythmia, we want to emphasise the importance of information
on the degree of malignancy of each type of early repolarisation
on risk-stratification accuracy in subjects with this common
pattern in the general population.
AIMÉ BONNY,
Hôpital Pitié Salpêtrière, Paris, France
References
1. Tikkanen JT, Anttonen O, Junttila JM,
et al
. Long-term outcome associ-
ated with early repolarization on electrocardiography.
N Engl J Med
2009;
361
: 2529–2537.
2. Boineau JP. The early repolarization variant – an electrocardiographic
enigma with both QRS and J-STT anomalies.
J Electrocardiol
2007;
40
(1): 3.e1–3.e10.
3. Haïssaguerre M, Derval N, Sacher F,
et al
. Sudden cardiac arrest associ-
ated with early repolarization.
N Engl J Med
2008;
358
: 2016–2023.
4. Bonny A, Ditah I, Larrazet F, Frank R. Prevalence and significance of
early repolarization pattern in Black Africans: Registry of two centers in
Cameroon. Abstract, ESC 2009, Barcelona, Spain.
