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Effect of Nebivolol Treatment on P Dispersion in Hypertensive Cases

Year 2006, Volume: 11 Issue: 3, 154 - 159, 01.06.2006

Abstract

Objectives: Hypertension is a important cardiovascular risk factors that promotes the development of atrial fibrillation (AF). Electrical heterogeneity and instability have been shown in the atrial conduction of hypertensive patients. P dispersion have been shown to be sensitive and specific noninvasive markers of atrial fibrillation. No study has been reported on the effect of Nebivolol on P dispersion. The objective of the present study is to Nebivolol treatment on the effect of P dispersion in hypertension of patient. Materials and Methods: The study included 65 patients (mean age 50.6±9.8; 31 males and 34 females) who were found to have essential hypertension. Biochemical parameters of all the patients in the study were analyzed, echocardiographies of all were taken and P dispersion was calculated in the ECG. All cases were put on 5 mg/day Nebivolol treatment. Biochemical parameter analyses, ECO and ECG were repeated in the 6th month. Results: Six-month Nebivolol treatment markedly reduced P dispersion and homogenized atrial myocardium, which provides a basis for atrial arrhythmias. ©2006, Fırat Üniversitesi, Tıp Fakültesi

References

  • Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis and redisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N–9N.
  • Levy S. Factors predisposing to the development of atrial fibrillation. PACE 1997;20:2670–74.
  • Calhoun DA, Bakir S, Oparil S. Etiology and pathogenesis of essential hypertension. Crawford MH, DiMarco JP. Cardiokogy. Mosby 2001 London pp. 3 1.1-3 1.10.
  • Tukek T, Akkaya V, Demirel S, Sozen AB, Kudat H, Atilgan D, et al. Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation. Am J Cardiol 2000;85:896–99.
  • Aytemir K, Amasyali B, Abali G, Kose S, Kilic A, Onalan O, Tokgozoglu L, Kabakci G, Ozkutlu H, Nazli N, Isik E, Oto A. The signal-averaged P-wave duration is longer in hypertensive patients with history of paroxysmal atrial fibrillation as compared to those without. Int J Cardiol 2005;103(1):37–40.
  • Cha YM, Redfield MM, Shen WK, Gersh BJ. Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle.Circulation. 2004 Jun 15;109(23):2839-43.
  • Solti F, Vecsey T, Kekesi V, et al. The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovasc Res 1989;23:882–886.
  • Gersh BJ, Braunwald E, Bonow RO: Chronic coronary artery disease, in Braunwald E, Zipes DP, Libby P (eds): Heart Disease: A Textbook of Cardiovascular Medicine (ed 6). Philadelphia, PA, Saunders, 2001, p 1290.
  • Kawano S, Hiraoka M, Sawanobori T: Electrocardiographic features of p waves from patients with transient atrial fibrillation. Jpn Heart J 1988:29;57-67.
  • Dilaveris PE, Gialafos EJ, Sideris S, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733–38.
  • Devereux RB. Method of recognition and assesment of left ventricular hypertrophy. Medicographia 1995;17:12.
  • Devereux RB, De simone G, Schlussel CY. Echocardiographic left ventricular mass predicts risk of developing subseguent borderline hypertension. Am Coll Cardiol 1990;15:210-18.
  • Castellanos A, Kessler KM, Myerburg RJ. The resting electrocardiogram. In Alexander RW, Schlant RC, Fuster V. Hurst's The Heart, volume 1, USA, The McGraw-Hill Companies, 9 th edition, 1998; pp.371.
  • Brilla CG, Funck RC, Rupp H Lisinopril-mediated regression of myocardial fibrosis in patients with hypertensive heart disease. Circulation. 2000 19;102(12):1388-93.
  • Mattioli AV, Bonatti S, Monopoli D, Zennaro M, Mattioli G Left atrial remodelling after short duration atrial fibrillation in hypertrophic hearts. Heart. 2005;91(1):91-92.
  • Yilmaz R, Demirbag R P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. Journal of Electrocardiology 2005:38;279–284.
  • Ozer N, Aytemir K, Ataler E, et al. P wave dispersion in hypertensive patients with paroxysmal AF. Pacing Clin Electrophysiol 2000;23:1859-1862.
  • Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunc K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.
  • Turhan H, Yetkin E, Senen K, Yilmaz MB, Ileri M, Atak R, et al. Effects of percutaneous mitral balloon valvuloplasty on P-wave dispersion in patients with mitral stenosis. Am J Cardiol 2002;89:607-09.
  • Turhan H, Yetkin E, Atak R, Altinok T, Senen K, Ileri M, et al. Increased P-wave duration and P-wave dispersion in patients with aortic stenosis. Ann Noninvasive Electrocardiol 2003;8:18.
  • Senen K, Turhan H, Riza Erbay A, Basar N, Saatci Yasar A, Sahin O, et al. P-wave duration and P-wave dispersion in patients with dilated cardiomyopathy. Eur J Heart Fail 2004;6:567-69.
  • Lammers WJ, Kirchhof C, Bonke FI, Allessie MA Vulnerability of rabbit atrium to reentry by hypoxia. Role of inhomogeneity in conduction and wavelength. Am J Physiol. 1992;262(1 Pt 2):H47-55.
  • Fareh S, Villemaire C, Nattel S. Importance of refractoriness heterogeneity in the enhanced vulnerability to atrial fibrillation induction caused by tachycardia-induced atrial electrical remodeling. Circulation 1998;98:2202-09.
  • Sugiura T, Iwasaka T, Takahashi N, Yuasa F, Takeuchi M, Hasegawa T, et al. Factors associated with atrial fibrillation in Q wave anterior myocardial infarction. Am Heart J 1991;121:1409- 12.
  • Erbay AR, Turhan H, Yasar AS, Bicer A, Senen K, Sasmaz H, Sabah I, Yetkin E. Effects of long-term beta-blocker therapy on P-wave duration and dispersion in patients with rheumatic mitral stenosis. Int J Cardiol. 2005 Jun 22;102(1):33-37.
  • Dilaveris PE, Gialafos EJ, Andrikopoulos GK, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 2000;23:352–58.
  • Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ. Effects of autonomic stimulation and blockade on signal-averaged P wave duration. J Am Coll Cardiol 1995;26:497-5002.
  • Coumel P. Paroxysmal atrial fibrillation: a disorder of autonomic tone? Eur Heart J 1994;15(Suppl A):9.
  • Tukek T, Akkaya V, Atilgan D, Demirel E, Ozcan M, Guven O, Korkut F. Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation. Clin Cardiol. 2001 Oct;24(10):676-80.
  • Camsari A, Pekdemir H, Akkus MN, Yenihan S, Doven O, Cin VG. Long-term effects of beta blocker therapy on P-wave duration and dispersion in congestive heart failure patients: a new effect? J Electrocardiol. 2003 Apr;36(2):111-16.
  • Janssens WJ, Xhonneux R, Janssen PAJ. Animal pharmacology of Nebivolol. Drug Investşgation 3 (Suppl. 1):1991;13-24.
  • The sixt report of Jiont İnternational Committe on Prevention, Detection, Evaluation and treatment of high blood pressure; NIH Publication, November 1997.
  • Van Bartel LMAB, Breed JGS, Joosten J, Kragten A, Lusterning FATh, Moolj JMV. Nebivolol in hypertension: a double bind placebo controlled multicenter study assessing its antihypertansiveefficacy and impact on quality of life. J Cardiovasc Pharmacol 1993;2:856-62.
  • Nodari S, Metra M, Dei Cas L. Beta-blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs. nebivolol. Eur J Heart Fail 2003;5(5):621-27.
  • Fountoulaki K, Dimopoulos V, Giannakoulis J, Zintzaras E, Triposkiadis F. Left ventricular mass and mechanics in mild-to- moderate hypertension: effect of nebivolol versus telmisartan.Am J Hypertens 2005;18 (2 Pt 1):171-7.
  • Wit AL, Hoffmann BF, Rosen M. Electrophysiology and pharmacology of cardiac arrhythmias IX. Cardiac electrophysiologic effect of beta adrenergic receptor stimulation and blockade. Am Heart J 1975; 90:795–803.
  • Opie LH, Sonnenblick EH, Frishman W, Thadani U. Beta- blocking agents. In: Opie LH, editor. Drugs for the Heart, Fourth edition. Philadelphia7 WB Saunders; 1995. p. 1–30.
  • Kabul Tarihi: 05.04.2006

Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi

Year 2006, Volume: 11 Issue: 3, 154 - 159, 01.06.2006

Abstract

Amaç: Hipertansiyon atriyal fibrilasyon (AF) gelişimini artıran önemli kardiyovasküler risk faktörlerindendir. Hipertansif hastaların atriyal iletisinde, elektriksel heterojenite ve instabilite olduğu gösterilmiştir. P dispersiyonu atriyal fibrilasyonun sensitif ve spesifik non-invaziv belirteci olabileceği gösterilmiştir. Nebivolol'ün P dispersiyonu üzerine etkisini inceleyen çalışma bildirilmemiştir. Çalışmamızın amacı nebivolol tedavisinin P dispersiyonu üzerine etkilerini irdelemek idi. Gereç ve Yöntem: Bu çalışmaya esansiyel hipertansiyon saptanan 65 hasta (yaş ortalaması 50.6±9.8; 31 erkek; 34 kadın) alındı. Çalışmaya katılan tüm hastaların biyokimyasal parametreleri, ekokardiyografileri ve EKG'de P dispersiyonu hesaplandı. Tüm olgulara nebivolol 5 mgr/gün başlandı. Altıncı ay sonunda biyokimyasal parametreler, EKO ve EKG tekrarlandı. Bulgular: Olguların EKG'lerinde belirlenen bazal ve tedavi sonrası P dispersiyonu 55.3±6'dan 33.5±7'e (p=0.000) gerilemiştir. Bu olumlu klinik düzelme sol ventrikül diyastolik fonksiyonundaki düzelme ve kan basıncındaki azalma ile kolere olup, sol atriyum çapı ile kolere değildi. Sonuç: Altı aylık nebivolol tedavisi belirgin olarak P dispersiyonu azaltıp atriyal aritmilere zemin hazırlayan atriyal miyokardı homojen hale getirmiştir. ©2006, Fırat Üniversitesi, Tıp Fakültesi

References

  • Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis and redisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 1998;82:2N–9N.
  • Levy S. Factors predisposing to the development of atrial fibrillation. PACE 1997;20:2670–74.
  • Calhoun DA, Bakir S, Oparil S. Etiology and pathogenesis of essential hypertension. Crawford MH, DiMarco JP. Cardiokogy. Mosby 2001 London pp. 3 1.1-3 1.10.
  • Tukek T, Akkaya V, Demirel S, Sozen AB, Kudat H, Atilgan D, et al. Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation. Am J Cardiol 2000;85:896–99.
  • Aytemir K, Amasyali B, Abali G, Kose S, Kilic A, Onalan O, Tokgozoglu L, Kabakci G, Ozkutlu H, Nazli N, Isik E, Oto A. The signal-averaged P-wave duration is longer in hypertensive patients with history of paroxysmal atrial fibrillation as compared to those without. Int J Cardiol 2005;103(1):37–40.
  • Cha YM, Redfield MM, Shen WK, Gersh BJ. Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle.Circulation. 2004 Jun 15;109(23):2839-43.
  • Solti F, Vecsey T, Kekesi V, et al. The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovasc Res 1989;23:882–886.
  • Gersh BJ, Braunwald E, Bonow RO: Chronic coronary artery disease, in Braunwald E, Zipes DP, Libby P (eds): Heart Disease: A Textbook of Cardiovascular Medicine (ed 6). Philadelphia, PA, Saunders, 2001, p 1290.
  • Kawano S, Hiraoka M, Sawanobori T: Electrocardiographic features of p waves from patients with transient atrial fibrillation. Jpn Heart J 1988:29;57-67.
  • Dilaveris PE, Gialafos EJ, Sideris S, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733–38.
  • Devereux RB. Method of recognition and assesment of left ventricular hypertrophy. Medicographia 1995;17:12.
  • Devereux RB, De simone G, Schlussel CY. Echocardiographic left ventricular mass predicts risk of developing subseguent borderline hypertension. Am Coll Cardiol 1990;15:210-18.
  • Castellanos A, Kessler KM, Myerburg RJ. The resting electrocardiogram. In Alexander RW, Schlant RC, Fuster V. Hurst's The Heart, volume 1, USA, The McGraw-Hill Companies, 9 th edition, 1998; pp.371.
  • Brilla CG, Funck RC, Rupp H Lisinopril-mediated regression of myocardial fibrosis in patients with hypertensive heart disease. Circulation. 2000 19;102(12):1388-93.
  • Mattioli AV, Bonatti S, Monopoli D, Zennaro M, Mattioli G Left atrial remodelling after short duration atrial fibrillation in hypertrophic hearts. Heart. 2005;91(1):91-92.
  • Yilmaz R, Demirbag R P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. Journal of Electrocardiology 2005:38;279–284.
  • Ozer N, Aytemir K, Ataler E, et al. P wave dispersion in hypertensive patients with paroxysmal AF. Pacing Clin Electrophysiol 2000;23:1859-1862.
  • Aytemir K, Ozer N, Atalar E, Sade E, Aksoyek S, Ovunc K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.
  • Turhan H, Yetkin E, Senen K, Yilmaz MB, Ileri M, Atak R, et al. Effects of percutaneous mitral balloon valvuloplasty on P-wave dispersion in patients with mitral stenosis. Am J Cardiol 2002;89:607-09.
  • Turhan H, Yetkin E, Atak R, Altinok T, Senen K, Ileri M, et al. Increased P-wave duration and P-wave dispersion in patients with aortic stenosis. Ann Noninvasive Electrocardiol 2003;8:18.
  • Senen K, Turhan H, Riza Erbay A, Basar N, Saatci Yasar A, Sahin O, et al. P-wave duration and P-wave dispersion in patients with dilated cardiomyopathy. Eur J Heart Fail 2004;6:567-69.
  • Lammers WJ, Kirchhof C, Bonke FI, Allessie MA Vulnerability of rabbit atrium to reentry by hypoxia. Role of inhomogeneity in conduction and wavelength. Am J Physiol. 1992;262(1 Pt 2):H47-55.
  • Fareh S, Villemaire C, Nattel S. Importance of refractoriness heterogeneity in the enhanced vulnerability to atrial fibrillation induction caused by tachycardia-induced atrial electrical remodeling. Circulation 1998;98:2202-09.
  • Sugiura T, Iwasaka T, Takahashi N, Yuasa F, Takeuchi M, Hasegawa T, et al. Factors associated with atrial fibrillation in Q wave anterior myocardial infarction. Am Heart J 1991;121:1409- 12.
  • Erbay AR, Turhan H, Yasar AS, Bicer A, Senen K, Sasmaz H, Sabah I, Yetkin E. Effects of long-term beta-blocker therapy on P-wave duration and dispersion in patients with rheumatic mitral stenosis. Int J Cardiol. 2005 Jun 22;102(1):33-37.
  • Dilaveris PE, Gialafos EJ, Andrikopoulos GK, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 2000;23:352–58.
  • Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ. Effects of autonomic stimulation and blockade on signal-averaged P wave duration. J Am Coll Cardiol 1995;26:497-5002.
  • Coumel P. Paroxysmal atrial fibrillation: a disorder of autonomic tone? Eur Heart J 1994;15(Suppl A):9.
  • Tukek T, Akkaya V, Atilgan D, Demirel E, Ozcan M, Guven O, Korkut F. Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation. Clin Cardiol. 2001 Oct;24(10):676-80.
  • Camsari A, Pekdemir H, Akkus MN, Yenihan S, Doven O, Cin VG. Long-term effects of beta blocker therapy on P-wave duration and dispersion in congestive heart failure patients: a new effect? J Electrocardiol. 2003 Apr;36(2):111-16.
  • Janssens WJ, Xhonneux R, Janssen PAJ. Animal pharmacology of Nebivolol. Drug Investşgation 3 (Suppl. 1):1991;13-24.
  • The sixt report of Jiont İnternational Committe on Prevention, Detection, Evaluation and treatment of high blood pressure; NIH Publication, November 1997.
  • Van Bartel LMAB, Breed JGS, Joosten J, Kragten A, Lusterning FATh, Moolj JMV. Nebivolol in hypertension: a double bind placebo controlled multicenter study assessing its antihypertansiveefficacy and impact on quality of life. J Cardiovasc Pharmacol 1993;2:856-62.
  • Nodari S, Metra M, Dei Cas L. Beta-blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs. nebivolol. Eur J Heart Fail 2003;5(5):621-27.
  • Fountoulaki K, Dimopoulos V, Giannakoulis J, Zintzaras E, Triposkiadis F. Left ventricular mass and mechanics in mild-to- moderate hypertension: effect of nebivolol versus telmisartan.Am J Hypertens 2005;18 (2 Pt 1):171-7.
  • Wit AL, Hoffmann BF, Rosen M. Electrophysiology and pharmacology of cardiac arrhythmias IX. Cardiac electrophysiologic effect of beta adrenergic receptor stimulation and blockade. Am Heart J 1975; 90:795–803.
  • Opie LH, Sonnenblick EH, Frishman W, Thadani U. Beta- blocking agents. In: Opie LH, editor. Drugs for the Heart, Fourth edition. Philadelphia7 WB Saunders; 1995. p. 1–30.
  • Kabul Tarihi: 05.04.2006
There are 38 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Necati Daglı This is me

İlgın Karaca This is me

Publication Date June 1, 2006
Published in Issue Year 2006 Volume: 11 Issue: 3

Cite

APA Daglı, N., & Karaca, İ. (2006). Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi. Fırat Tıp Dergisi, 11(3), 154-159.
AMA Daglı N, Karaca İ. Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi. Fırat Tıp Dergisi. June 2006;11(3):154-159.
Chicago Daglı, Necati, and İlgın Karaca. “Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi”. Fırat Tıp Dergisi 11, no. 3 (June 2006): 154-59.
EndNote Daglı N, Karaca İ (June 1, 2006) Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi. Fırat Tıp Dergisi 11 3 154–159.
IEEE N. Daglı and İ. Karaca, “Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi”, Fırat Tıp Dergisi, vol. 11, no. 3, pp. 154–159, 2006.
ISNAD Daglı, Necati - Karaca, İlgın. “Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi”. Fırat Tıp Dergisi 11/3 (June 2006), 154-159.
JAMA Daglı N, Karaca İ. Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi. Fırat Tıp Dergisi. 2006;11:154–159.
MLA Daglı, Necati and İlgın Karaca. “Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi”. Fırat Tıp Dergisi, vol. 11, no. 3, 2006, pp. 154-9.
Vancouver Daglı N, Karaca İ. Hipertansif Olgularda Nebivolol Tedavisinin P Dispersiyonu Üzerine Etkisi. Fırat Tıp Dergisi. 2006;11(3):154-9.