Abstract
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. Assess the association of P-wave dispersion with blood pressure and nutritional status in a pediatric population. 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. 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. 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.
Highlights
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
P-wave dispersion and mean arterial pressure (MAP) were significantly correlated in prehypertensive and hypertensive children
Associations observed between P-wave dispersion and MAP in normotensive, prehypertensive and hypertensive children suggest potential for early detection of EKG patterns showing vulnerability
Summary
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. In essential hypertension (HT) in adults, a significant association has been demonstrated between changes in left ventricular geometry and P-wave dispersion (Pd), the difference between maximum and minimum P-wave duration measured on simultaneously recorded 12-lead EKG.[1]. With still greater risk among patients with longer maximum P-wave duration (134±11 ms vs 128±13 ms); a Pd cutoff of 46 ms was found to predict PAF in patients with hypertrophic cardiomyopathy, with 76% sensitivity and 82% specificity.[5] A study in dogs found higher Pd values predictive of PAF recurrence after cardioversion.[6] High Pd values have been found in patients with metabolic syndrome and HT risk.[7]
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