title: Patients with a hypertensive response to exercise have impaired left ventricular diastolic function.
abstract: An exaggerated increase in systolic blood pressure prolongs myocardial relaxation and increases left ventricular (LV) chamber stiffness, resulting in an increase in LV filling pressure. We hypothesize that patients with a marked hypertensive response to exercise (HRE) have LV diastolic dysfunction leading to exercise intolerance, even in the absence of resting hypertension. We recruited 129 subjects (age 63+/-9 years, 64% male) with a preserved ejection fraction and a negative stress test. HRE was evaluated at the end of a 6-min exercise test using the modified Bruce protocol. Patients were categorized into three groups: a group without HRE and without resting hypertension (control group; n=30), a group with HRE but without resting hypertension (HRE group; n=25), and a group with both HRE and resting hypertension (HTN group; n=74). Conventional Doppler and tissue Doppler imaging were performed at rest. After 6-min exercise tests, systolic blood pressure increased in the HRE and HTN groups, compared with the control group (226+/-17 mmHg, 226+/-17 mmHg, and 180+/-15 mmHg, respectively, p<0.001). There were no significant differences in LV ejection fraction, LV end-diastolic diameter, and early mitral inflow velocity among the three groups. However, early diastolic mitral annular velocity (E') was significantly lower and the ratio of early diastolic mitral inflow velocity (E) to E' (E/E') was significantly higher in patients of the HRE and HTN groups compared to controls (E': 5.9+/-1.6 cm/s, 5.9+/-1.7 cm/s, 8.0+/-1.9 cm/s, respectively, p<0.05). In conclusion, irrespective of the presence of resting hypertension, patients with hypertensive response to exercise had impaired LV longitudinal diastolic function and exercise intolerance.
authors: Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan.
authors: Takeshi
authors: T
authors: Takamura
authors: Katsuya
authors: K
authors: Onishi
authors: Tadafumi
authors: T
authors: Sugimoto
authors: Tairo
authors: T
authors: Kurita
authors: Naoki
authors: N
authors: Fujimoto
authors: Kaoru
authors: K
authors: Dohi
authors: Takashi
authors: T
authors: Tanigawa
authors: Naoki
authors: N
authors: Isaka
authors: Tsutomu
authors: T
authors: Nobori
authors: Masaaki
authors: M
authors: Ito
mesh_terms: D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left