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

Ilgin Karaca1, Polat Durukan, Necati Dagli

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

Advances in Therapy
|December 2, 2008
PubMed

Insights

Sudden blood pressure changes in hypertensive urgency can affect atrial conduction. Rapidly lowering blood pressure with nitroprusside stabilized atrial activity, potentially reducing atrial fibrillation risk.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Hypertension Research

Background:

  • Hypertensive urgency causes atrial pressure and strain, leading to conduction abnormalities.
  • Left ventricular diastolic dysfunction and hypertrophy (LVH) contribute to unstable atrial electrophysiology.
  • Elevated maximum P-wave duration (P(max)) and P-wave dispersion (PWD) may signal atrial fibrillation (AF) risk.

Purpose of the Study:

  • To investigate the impact of acute hemodynamic changes in hypertensive urgency on P(max) and PWD.
  • To assess if P(max) and PWD changes correlate with AF risk in this patient group.

Main Methods:

  • Included 102 patients with hypertensive urgency (SBP >180 mmHg, DBP >110 mmHg).
  • Administered intravenous nitroprusside, adjusting dosage based on blood pressure response.
  • Utilized echocardiography and electrocardiography to measure diastolic function, P(max), and PWD.

Main Results:

  • Nitroprusside treatment significantly decreased P(max) (99.9 to 88.5 msec) and PWD (60.1 to 43.9 msec) (P<0.001).
  • Most patients exhibited LVH and diastolic dysfunction, which improved post-treatment.
  • Observed improvements in E/A ratio, deceleration time, and isovolumetric relaxation time.

Conclusions:

  • Acute blood pressure reduction in hypertensive urgency normalizes P(max) and PWD.
  • This normalization suggests improved atrial conduction stability, potentially lowering AF risk.
  • Nitroprusside effectively mitigates electrophysiological instability associated with hypertensive urgency.
Abstract

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