Systolic and diastolic BP tend to increase with age in normal subjects. This increase and the range of accepted normal BP by age and gender are widely accepted. All of our subjects’ BPs fell within the established 95 percent confidence levels for their age. Because the subjects in the bimodal P-wave group were slightly younger than those in the unimodal P-wave group, age cannot account for their higher BP readings. Instead, the P-wave-related increase in BP in these children might reflect an intrinsic early hypertensive tendency. In addition to increasing BP, cardiac structural and functional alterations occur during aging and with exercise training. All of our subjects were within a narrow 1.5-year age range and hence the effects of aging on cardiac structure and function were minimized but not eliminated. Our subjects were all normal active adolescents, although the type and extent of their regular physical activity were not quantified in the present study. The contribution of variable levels of exercise training and physical exertion, while minimal, to the observed changes in cardiac structure and function cannot be determined. birth control pills
Ambulatory BP monitoring correlates more closely than conventional BP measurements with the degree of cardiac target organ manifestations of hypertension, especially LV hypertrophy. Two-hour averaged automated BP recording provides an acceptable and convenient representation of whole-day BP Two-hour average systolic BP was higher in the bimodal P-wave group than in the unimodal P-wave group, suggesting that changes in BP might be associated with changes in the cardiovascular system; bimodal P-waves may be a marker of these changes. Bimodal P-waves may be a passive reflection of increased BP, or of the mass or filling characteristics of the left ventricle, or an as yet unappreciated abnormality. It is possible that the mechanisms sustaining essential hypertension are inherited. Thus, bimodal P-waves may be a part of or a marker of a genetically transmitted condition that could lead to intrinsic cardiac abnormalities independently of BP changes. Longitudinal studies will be required to determine the longterm significance of our findings.
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