Hypertension is not usually diagnosed until adulthood, but recent studies have suggested that cardiovascular changes associated with adult hypertension also may he seen in children. Early hypertension is frequently characterized by alterations in heart rate and cardiac output as well as in peripheral resistance. Electrocardiographic changes indicating increased left ventricular muscle mass have been identified in severely hypertensive children, and deviations from normal P-wave morphology have been described with left ventricular hypertrophy and in conjunction with valvular heart disease in adults. Changes in P-wave morphology may reflect altered left atrial depolarization as a consequence of hemodynamic alterations from valvular heartdisease. Previous studies have suggested that P-wave morphology may reflect changes in left ventricular diastolic function in normotensive subjects and hypertensive patients. To evaluate P-wave morphology as an indicator of very early cardiac changes related to blood pressure (BP), we examined young normotensive adolescents with 12-lead scalar electrocardiography (ECG), M-mode echocardiography, and two-dimensional echocardiography, and two-hour automated BP monitoring. Buy Asthma Inhalers Online
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