title: Isolated T-wave abnormalities and evaluation of left ventricular wall motion after nifedipine for severe hypertension.
abstract: Rapid reduction of blood pressure by vasodilators in severe hypertensives has been associated with T-wave inversion. The significance of these changes in the absence of chest pain or other manifestations of ischemia is not known. To determine if these T-wave inversions are due to myocardial ischemia, we obtained electrocardiograms and left ventricular wall motion studies (2-D echocardiography) before and 1 h after rapid blood pressure reduction with nifedipine in 23 severe hypertensives. One hour after 10 mg nifedipine blood pressure was markedly reduced from 189 +/- 6/117 +/- 3 (mean +/- SE) to 151 +/- 5/91 +/- 3 mm Hg (P less than .001). New T-wave inversions developed in 6 of 23 (26%) subjects, but blinded evaluation of 2-D echocardiograms revealed no new wall motion abnormalities. Wall motion score, which at pretreatment was abnormal in 11 of 23 patients, improved significantly after nifedipine from 1.4 +/- 0.1 to 1.2 +/- 0.1 (P less than .05). Therefore, rapid and marked reduction of blood pressure with nifedipine is accompanied by a high incidence of asymptomatic T-wave inversions which are not accompanied by left ventricular wall motion abnormalities, suggesting that significant myocardial ischemia did not occur.
authors.affiliation: Department of Medicine, Mount Sinai Medical Center, New York, New York 10029.
authors.forename: R A
authors.initials: RA
authors.lastname: Phillips
authors.forename: M E
authors.initials: ME
authors.lastname: Goldman
authors.forename: M
authors.initials: M
authors.lastname: Ardeljan
authors.forename: H B
authors.initials: HB
authors.lastname: Eison
authors.forename: S
authors.initials: S
authors.lastname: Shimabukuro
authors.forename: L R
authors.initials: LR
authors.lastname: Krakoff
mesh_terms: D004452:Echocardiography; D004562:Electrocardiography; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008875:Middle Aged; D009068:Movement / Q000187:drug effects; D009543:Nifedipine / Q000627:therapeutic use*; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D009543:Nifedipine