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P-wave dispersion: a possible warning sign of hypertension in children
Elibet Chávez1, Emilio González, María del Carmen Llanes
1Ernesto Che Guevara Heart Center, Santa Clara, Cuba. elibetcg@cardiovc.sld.cu.
Insights
P-wave dispersion is associated with higher blood pressure in children, indicating potential for early detection of hypertension risk. This simple EKG measure may help identify children needing early intervention for hypertensive cardiomyopathy.
Area of Science:
- Pediatric Cardiology
- Clinical Electrophysiology
- Public Health Nutrition
Background:
- Adult studies link increased P-wave dispersion to hypertension, left ventricular hypertrophy, and atrial enlargement.
- Pediatric literature on P-wave dispersion in relation to hypertension and obesity is limited.
- P-wave dispersion reflects atrial electrical activity and can be influenced by cardiac remodeling.
Purpose of the Study:
- To assess the association between P-wave dispersion and blood pressure.
- To evaluate the relationship of P-wave dispersion with nutritional status in children.
- To explore P-wave dispersion as a potential early marker for cardiovascular risk in pediatric populations.
Main Methods:
- Cross-sectional study of 656 children aged 8-11 years.
- Electrocardiogram (EKG) and blood pressure measurements were performed.
- P-wave dispersion, systolic, diastolic, and mean arterial pressure (MAP) were analyzed in relation to nutritional status (BMI) and blood pressure categories (normal, prehypertension, hypertension).
Main Results:
- Mean P-wave dispersion was significantly higher in prehypertensive and hypertensive children compared to normotensive children (p ≤0.05).
- P-wave dispersion showed a significant correlation with MAP in prehypertensive and hypertensive children.
- Overweight and obese children with high P-wave dispersion were more likely to be prehypertensive or hypertensive.
Conclusions:
- P-wave dispersion is associated with elevated blood pressure in children, suggesting its utility for early risk detection.
- This noninvasive EKG parameter may aid in identifying children at risk for hypertensive cardiomyopathy.
- Further research with larger cohorts is recommended to validate these findings for guiding timely interventions.
Introduction:
Hypertension and obesity in adults have been linked to increased EKG P-wave dispersion; the association has been shown in relation to hypertension, left ventricular hypertrophy and atrial enlargement. Though studies in children have linked P-wave dispersion to left ventricular hypertrophy, scant pediatric literature relates P-wave dispersion to hypertension and obesity.
Objective:
Assess the association of P-wave dispersion with blood pressure and nutritional status in a pediatric population.
Methods:
This cross-sectional study is part of the PROCDEC II project for pediatric hypertension diagnosis and control in Santa Clara, Cuba. Twelve-lead EKG and four blood pressure readings were conducted on a sample of 656 children aged 8-11 years. Blood pressure <90th percentile for age, sex and height was considered normal; 90th-95th percentile, prehypertension; and >95th percentile, hypertension. The main study variables were P-wave dispersion and systolic, diastolic and mean arterial pressure (MAP). Secondary variables were sex, height, weight, and body mass index. Comparisons of means, analysis of variance and linear correlations were done.
Results:
Mean P-wave dispersion differed significantly (p ≤0.05) among normotensive (30.10 ms), prehypertensive (32.99 ms) and hypertensive children (39.14 ms), as did mean MAP (p <0.05). P-wave dispersion and MAP were significantly correlated in prehypertensive and hypertensive children. Most overweight and obese children with high P-wave dispersion were prehypertensive or hypertensive.
Conclusions:
Associations observed between P-wave dispersion and MAP in normotensive, prehypertensive and hypertensive children suggest potential for early detection of EKG patterns showing vulnerability. Given the relationship between increased P-wave dispersion and hypertension already described in adults, use of P-wave dispersion could be a simple, economical and noninvasive method of predicting risk of hypertensive cardiomyopathy in prehypertensive and hypertensive children; this in turn could guide timely, effective treatment and secondary prevention. Similar studies on a larger sample are needed to corroborate these results.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.