title: Relationship of ambulatory arterial stiffness index with blood pressure response to exercise in the early stages of hypertension.
abstract: OBJECTIVE
  We sought to investigate the plausible interrelationship of exaggerated blood pressure response during exercise (EBPR) with ambulatory arterial stiffness index (AASI) in never-treated patients with uncomplicated essential hypertension.
  
  
  METHODS
  Ninety-nine never-treated hypertensive patients (aged 50.7 years, 61 male) underwent 24 h ambulatory blood pressure (BP) recording, complete echocardiographic study and treadmill exercise testing and were classified as patients with (n=36) and without EBPR (n=63) based on the systolic BP elevation at peak exercise (>or=210 mmHg for men and >or=190 mmHg for women). Arterial stiffness was evaluated by means of both AASI and pulse wave velocity (PWV).
  
  
  RESULTS
  Hypertensives with EBPR, compared with those without EBPR, exhibited significantly higher 24 h systolic BP and pulse pressure (by 3.8 mmHg, P=0.041 and by 7.2 mmHg, P<0.001, respectively), and decreased peak early diastolic velocity and peak early diastolic velocity/peak atrial systolic velocity ratio (by 1.1 cm/s and by 0.11, both P<0.05, respectively). PWV and AASI values were higher in the EBPR group compared with the normal response group independently of confounders (by 0.9 m/s, P<0.001 and by 0.06, P=0.043, respectively). PWV (beta=0.308, P=0.008) and 24-h pulse pressure (beta=0.297, P=0.010), but not AASI, were independently associated with peak exercise systolic BP.
  
  
  CONCLUSIONS
  EBPR constitutes a sign of premature cardiovascular stiffening in the setting of uncomplicated hypertension. The close relationship between EBPR and PWV but not AASI enhances the concept of PWV as a superior measure of arterial stiffness and constitutes an important factor in the interpretation of EBPR-linked cardiovascular risk.
authors.affiliation: First Cardiology Clinic, Hippokration Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Dimitriadis
authors.forename: Peter
authors.initials: P
authors.lastname: Kokkinos
authors.forename: Charles
authors.initials: C
authors.lastname: Faselis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
authors.forename: Andreas
authors.initials: A
authors.lastname: Michaelides
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D004548:Elasticity; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D014655:Vascular Resistance