Exercise blood pressure, cardiac structure, and diastolic function in young normotensive patients with polycystic kidney disease: a prehypertensive state.
BACKGROUND
Increased left ventricular mass (LVM) and left ventricular hypertrophy have been found in early stages of autosomal dominant polycystic kidney disease (ADPKD). The mechanisms that lead to an increase in LVM in this population are unknown. The aim of this study is to evaluate blood pressure (BP) response to exercise and very early alterations in cardiac structure and diastolic function in young normotensive patients with ADPKD.


METHODS
Color Doppler echocardiography and exercise treadmill testing according to the Bruce protocol were performed in 18 young normotensive patients with ADPKD and 18 healthy subjects.


RESULTS
LVM index was greater and isovolumic relaxation time (IVRT) was longer in patients with ADPKD than controls (93.3 +/- 21.4 versus 77.5 +/- 18.6 g/m2; P = 0.02; 100 +/- 20.2 versus 80 +/- 9.7 milliseconds; P = 0.001, respectively). Exercise capacity in metabolic equivalents was similar in both groups. Systolic BP response during exercise and recovery were similar in both groups. Diastolic BP decreased during exercise, but the magnitude of decrease was lower in patients with ADPKD than controls (P = 0.01). During recovery, patients with ADPKD showed a greater sustained diastolic BP than controls (P = 0.02). Patients with ADPKD with an exaggerated systolic BP response had a greater LVM index than those with a normal response (112.1 +/- 10.4 versus 84 +/- 19.2 g/m2; P = 0.001). Multivariate regression analysis showed that exercise systolic BP and diastolic BP were independent predictors of LVM index and IVRT, respectively.


CONCLUSIONS
Young normotensive patients with ADPKD showed increased LVM index and prolonged IVRT, which are related to exercise BP response. Exaggerated diastolic BP response during exercise suggests an impaired capacity for exercise-induced vasodilatation and may indicate a greater risk for the development of future hypertension.
Martinez-Vea
Alberto
A
Nephrology Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain. amtz@hjxxiii.scs.es
Bardaj
Alfredo
A
Gutierrez
Cristina
C
Garca
Carmen
C
Peralta
Carmen
C
Marcas
Luis
L
Oliver
Jesús Angel
JA
D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology*; D004198:Disease Susceptibility; D018618:Echocardiography, Doppler, Color; D015444:Exercise; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008019:Life Style; D008297:Male; D009206:Myocardium / Q000473:pathology*; D016891:Polycystic Kidney, Autosomal Dominant / Q000473:pathology / Q000503:physiopathology*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014664:Vasodilation