Their ECGs were normal by standard criteria, yet the P-waves were notched or biphasic in 22 subjects. These P-waves were morphologically and dimensionally normal, but when present, they predicted cardiac structural and functional differences among our normal adolescent subjects. Specifically, they were associated with higher measurements of systolic BP and LV mass than the subjects with unimodal P-waves, although these measurements were all within the conventionally defined normal range. Thus, the presence of a bimodal P-wave in adolescents potentially may be indicative of two manifestations of the prehypertensive state: a tendency to a slight elevation in BP and an increase in LV muscle mass. The bimodal P-wave group of adolescent subjects had higher systolic BP, greater LV mass, and stroke volume than the unimodal P-wave group. These findings are similar to the early findings in young hypertensives, again suggesting that bimodal P-waves identify a group of adolescents who, while still normal by standard assessment, have cardiac structural and functional characteristics that tend toward those seen in hypertensive patients. buy ampicillin
Echocardiographically detectable LV hypertrophy is a frequent finding in young hypertensive patients. In adults, isolated LV hypertrophy is associated with an increased risk of cardiovascular morbid events. Larger left atrial dimensions have been reported to be associated with greater LV mass and altered LV filling in hypertensive patients, suggesting that left atrial size may be a marker of early cardiac involvement in hypertensive heart disease. The strong linear correlation of left atrial dimension with LV mass in our normotensive study group, especially in the subjects with bimodal P-waves, suggests that left atrial size increases in parallel with LV mass in normotensive subjects and possibly that the presence of bimodal P-waves in ECG lead V, may reflect very early cardiac involvement in hypertensive heart disease.
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