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The effect of rapid blood pressure control on P-wave dispersion in hypertensive urgency

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Abstract

Introduction

A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (Pmax) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on Pmax and PWD, which may indicate the risk of atrial fibrillation (AF) development in hypertensive urgency.

Methods

The study included patients diagnosed as hypertensive urgency (systolic blood pressure ≥180 mmHg, diastolic blood pressure ≥110 mmHg). Nitroprusside was started at a dose of 0.2 μg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and Pmax, respectively.

Results

The study enrolled 102 patients (mean age 57.9±11.6 years; 32 [31.4%] males, and 70 [68.6%] females). Pmax decreased from 99.9±11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5±9.3 msec (95% CI 86.6, 90.3) (P<0.001), while PWD decreased from 60.1±7.4 msec (95% CI 58.7, 61.6) to 43.9±6.7 msec (95% CI 42.5, 45.2) (P<0.001). In addition, most patients had LVH and diastolic dysfunction. After nitroprusside treatment improvements in indicators of diastolic functions such as E/A ratio, deceleration time, and isovolumetric relaxation time were observed.

Conclusion

The change observed in Pmax and PWD in hypertensive urgency may be associated with the rapid change in blood pressure and atrial strain, sympathetic nervous system activation, relative myocardial ischemia, and left ventricular diastolic dysfunction. Rapid regulation of blood pressure with nitroprusside brought about a marked decrease in Pmax and PWD in our patients. This improvement was interpreted as atrial conduction acquiring a stable and homogeneous character, which may reduce the risk of AF development in hypertensive urgency.

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Authors and Affiliations

  1. Department of Cardiology, Firat University Hospital, Elazig, Turkey

    Ilgin Karaca, Necati Dagli & Mustafa Yavuzkir

  2. Department of Emergency Medicine, Erciyes University Medical School, Kayseri, Turkey

    Polat Durukan & İbrahim Ikizceli

  3. Elazig Government Hospital, Elazig, Turkey

    Mehmet Balin

Authors
  1. Ilgin Karaca
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  2. Polat Durukan
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  3. Necati Dagli
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  4. Mustafa Yavuzkir
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  5. İbrahim Ikizceli
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  6. Mehmet Balin
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Correspondence to Necati Dagli.

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Karaca, I., Durukan, P., Dagli, N. et al. The effect of rapid blood pressure control on P-wave dispersion in hypertensive urgency. Adv Therapy 25, 1303–1314 (2008). https://doi.org/10.1007/s12325-008-0120-0

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