ArticleHypertension research : official journal of the Japanese Society of Hypertension2026
Digital electrocardiogram-measured P-wave duration and hypertensive heart disease are associated with cardiovascular events in patients with cardiovascular risks.
Article in Hypertension research : official journal of the Japanese Society of Hypertension, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Prolonged P-wave duration on electrocardiogram (ECG) quantitatively reflects atrial remodeling and is associated with atrial fibrillation, cardiovascular death. We examined the association between P-wave duration and the risk of cardiovascular events with and without left ventricular hypertrophy (LVH) on ECG. The COUPLING Study, which examined prognosis in a Japanese population at cardiovascular risk, included 4288 subjects for whom digital ECG analysis was available. The primary event was a composite endpoint of stroke, ischemic heart disease, sudden death, hospitalization for heart failure, and aortic dissection. The cutoff value of the P-wave in ECG was 140 ms, and patients were divided into two groups: a control group with normal P-wave duration (n = 3975) and a prolonged P-wave duration group (n = 313). The association between prolonged P-wave duration and cardiovascular events was investigated in the presence of LVH using the Cornell product criteria for ECG. The mean age of subjects was 69 ± 11 years, and 50% were male. The median follow-up period was 5.0 years, and primary events were observed in 178 patients. The hazard ratio of primary events for prolonged P-wave duration was 2.20 (95% confidence interval [CI] 1.47-3.29, p < 0.001) after adjusting for age, gender, and comorbidity. In patients without LVH, prolonged P-wave duration was associated with a 1.86-fold higher primary endpoint risk (95% CI 1.17-2.96, p = 0.008), while prolonged P-wave duration was associated with a 2.76-fold higher primary event risk in patients with LVH (95% CI 1.10-6.89, p = 0.030), and the association was stronger in patients with LVH on ECG (synergistic effect: p = 0.007). Cardiovascular risk factors can advance atherosclerosis. Elevated sympathetic nerve activity affects the development of atrial fibrillation, and the renin-angiotensin-aldosterone system affects atrial and ventricular filling pressures as well as volume overload. In these processes, prolonged P-wave, reflecting atrial remodeling, and BNP, reflecting impaired ventricular function, indicates that atherosclerosis is developing. Prolonged P-wave in advanced ECG-LVH is a risk for the occurrence of cardiovascular events.
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