고혈압 환자에서 항고혈압 약제에 의한 혈압감소와 P파 분산의 변화

Abstract

Correlation between the blood pressure lowering and the change of P-wave dispersion in hypertensive patients using antihypertensives

Lee Jae-Kwang Advisor : Prof. Hong Soon-pyo, M.D., Ph.D. Department of Medicine, Graduate School of Chosun University

Background : In hypertensive patients, it is well-known that PWD(P wave dispersion = Pmax duration - Pmin duration) is associated with the level of BP and the level of PWD correlates with the prevalence of arrhythmias and left atrial enlargement in previous studies. And all the antihypertensives showed the ability of shortening PWD regardless of their classes. However, no study has done to prove the different effects between different classes of antihypertensives.

Aim of study : We tried to assess the improvement of PWD between different classes of antihypertensives(angiotensin receptor blockers and calcium channel blockers, ARB and CCB respectively).

Methods : A retrospective analysis was conducted to assess the change of PWD within the population of 33 subjects (15 males, 18 females, in adult) in chosun university outpatient. The data were collected between January 2006 and September 2008. 12-lead ECG were recorded from all patients before and after antihypertensives( MAC 5000, GE medical system information technologies, Gmbh, Treiburg, Germany). And PWD was calculated using electronic caliper(Screen Caliper version 2.2 from iconico). Anova analysis was performed to analyze the change of PWD after using two different classes of antihypertensives. And we used the Tukey analysis to find the superiority in decreasing PWD within two antihypertensives.

Results : There was no statistical difference between the two groups at number of patients, male proportion, mean age, mean systolic BP and diastolic BP before using antihypertensives. Before using antihypertensives, mean systolic and diastolic BP in ARB group were 165.2 ± 6.7 mmHg and 94.0 ± 8.1 mmHg, respectively. And for CCB group they were 165.5 ± 6.3 mmHg and 89.7 ± 8.3 mmHg, respectively. And after using antihypertensives, mean systolic and diastolic BP in ARB group were 123.4 ± 8.0 mmHg and 72.8 ± 7.1 mmHg. And for CCB group they were 126.2 ± 10.6 mmHg and 72.3 ± 10.3 mmHg, respectively. Both systolic and diastolic BP significantly decreased after antihypertensives in both groups, but there were no statistical difference of decreased systolic and diastolic BP between two groups. (p value = 0.726, p value = 0.151, respectively) The mean △PWD was 33.6 ± 6.33 ms in ARB group and 23.7 ± 9.55 ms in CCB group. With Tukey analysis, △PWDARB - △PWDCCB was 9.8 ms and there was a statistical difference of △PWD between two groups(p value = 0.002).

Conclusions : Angiotensin receptor blockers are superior to calcium channel blockers in decreasing PWD. There are several limitations of this study including small numbers of population. And further study is required to find difference in decreasing PWD between the subclasses of angiotensin receptor blockers with prospective study and more subjects.

Keywords : PWD, antihypertensives