Article Text

Download PDFPDF
Reliability of ultrashort electrocardiographic indices in hypertension: the quest for a clinically applicable prognostic marker
  1. Keren Politi1,
  2. Keren Kaminer2,
  3. Udi Nussinovitch3
  1. 1 Neonatal Neurology Clinic, Schnider Children’s Medical Center, Alyn Children and Adolescent Rehabilitation Center, Petach Tikva, Israel
  2. 2 Department of Endocrinology, Rabin Medical Center, Petach Tikva, Israel
  3. 3 Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
  1. Correspondence to Dr Udi Nussinovitch, Department of Cardiology, Meir Medical Center, Kfar Saba 44281, Israel; udi.nussinovitch{at}


Heart rate variability (HRV) is an accepted clinical tool for evaluating autonomic nervous system function and a marker of adverse cardiac outcome. Although 5 min long HRV recordings are considered methodologically acceptable, it remains impractical in most clinical settings. Also, while some ultrashort HRV (usHRV) parameters were found useful in healthy individuals, their applicability to patients with cardiovascular risk factors is largely unknown. Therefore, our goal was to evaluate the reliability of ultrashort ECG (usECG) indices for HRV among patients with hypertension. One-hundred and two patients with essential hypertension were included. HRV was recorded for 5 min in strictly monitored settings. HRV parameters from randomly chosen 1 min and 10 s series were analyzed. Excellent correlations were found between 1 min SD of RR interval (SDNN) (intraclass correlation coefficient (ICC) 0.973), 10 s SDNN (ICC 0.92) and 5 min SDNN results. An excellent correlation was also found between 1 min root  mean square of successive differences in RR intervals (RMSSD) (ICC 0.992), 10 s RMSSD (ICC 0.982) and 5 min RMSSD. Logarithmic transformation of ultrashort 1 min HRV-triangular index using the natural logarithm (Ln) also had excellent correlation with 5 min measurements (ICC 0.9). Also, excellent correlations were found between 10 s and 1 min Ln(RMSSD), 10 s Ln(RMSSD) and 5 min measurements. Other HRV parameters measured from 1 min and 10 s periods showed lower correlations. In conclusion, evaluation of SDNN, RMSSD or Ln(RMSSD) from 10 s ECG recordings can be used to estimate autonomic nervous system function in patients with hypertension. These appealing markers can be readily calculated from any standard ECG tracing. The prognostic significance of ultrashort SDNN and ultrashort RMSSD in patients with cardiovascular risk factors needs to be determined in future prospective cohort studies.

  • hypertension
  • heart rate variability (HRV)
  • ultra-short electrocardiography (usECG)
  • autonomic nervous system (ANS)
  • dysautonomia

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors KP and KK collected the data. KP and UN planned the study. KK and UN performed the statistical analysis. UN wrote the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The Institutional Review Board approved the research protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on reasonable request.

  • Patient consent for publication Not required.