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.
Similar content being viewed by others
Article PDF
References
Gandhi SK, Powers JC, Nomeir AM, et al: The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 2001; 344: 17–22.
Vasan RS, Benjamin EJ : Diastolic heart failure—no time to relax. N Engl J Med 2001; 344: 56–59.
Peng QU, Yanchun DING, Daozi XIA, Hongyan WANG, Xiaohong TIAN : Variations in cardiac diastolic function in hypertensive patients with different left ventricular geometric patterns. Hypertens Res 2001; 24: 601–604.
Little WC, Ohno M, Kitzman DW, et al: Determination of left ventricular chamber stiffiness from the time for deceleration of early left ventricular filling. Circulation 1995; 92: 1933–1939.
Wachtell K, Bella JN, Rokkedal J, et al: Change in diastolic left ventricular filling after one year of antihypertensive treatment. Circulation 2002; 105: 1071–1076.
Stratton JR, Levy WC, Cerqueira MD, et al: Cardiovascular responses to exercise: effects of aging and exercise training in healthy men. Circulation 1994; 89: 1648–1655.
Arita M, Hashizume T, Wanaka Y, et al: Effects of antihypertensive agents on blood pressure during exercise. Hypertens Res 2001; 24: 671–678.
Fleg JL, O'Connor F, Gerstenblith G, et al: Impact of age on the cardiovascular response to dynamic upright exercise in healthy men and women. J Appl Physiol 1995; 78: 890–900.
Fagard R, Staessen J, Thijs L, Amery A : Prognostic significance of exercise versus resting blood pressure in hypertensive men. Hypertension 1991; 17: 574–578.
Warner JG Jr, Metzger DC, Kitzman DW, Wesley DJ, Little WC : Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise. J Am Coll Cardiol 1999; 33: 1567–1572.
Pickering TG, Davidson K, Gerin W, Schwartz JE : Masked hypertension. Hypertension 2002; 40: 795–796.
Bruce RA, Kusumi F, Hosmer D : Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. Am Heart J 1973; 85: 546–562.
Aronson D, Sella R, Sheikh-Ahmad M, et al: The association between cardiorespiratory fitness and C-reactive protein in subjects with the metabolic syndrome. J Am Coll Cardiol 2004; 44: 2003–2007.
Mottram PM, Haluska B, Yuda S, et al: Patients with a hypertensive response to exercise have impaired systolic function without diastolic dysfunction or left ventricular hypertrophy. J Am Coll Cardiol 2004; 43: 848–853.
Singh JP, Larson MG, Manolio TA, et al: Blood pressure response during treadmill testing as a risk factor for new-onset hypertension: the Framingham Heart Study. Circulation 1999; 99: 1831–1836.
Lauer MS, Levy D, Anderson KM, Plehn JF : Is there a relationship between exercise systolic blood pressure response and left ventricular mass? The Framingham Heart Study. Ann Intern Med 1992; 116: 203–210.
Yamanaka-Funabiki K, Onishi K, Tanabe M, et al: Single beat determination of regional myocardial strain measurements in patients with atrial fibrillation. J Am Soc Echocardiogr 2006; 19: 1332–1337.
Armstrong WF, Feigenbaum H : Echocardiography. in Braunwald E, Zipes DP, Libby P ( eds): Heart Disease: A Text of Cardiovascular Medicine, 6th ed. 2001, p 167.
Gorcsan J 3rd, Deswal A, Mankad S, et al: Quantification of the myocardial response to low-dose dobutamine using tissue Doppler echocardiographic measures of velocity and velocity gradient. Am J Cardiol 1998; 81: 615–623.
Ommen SR, Nishimura RA, Appleton CP, et al: Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 2000; 102: 1788–1794.
Nagueh SF, Middleton KJ, Kopelen HA, et al: Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997; 30: 1527–1533.
McCullough PA, Lepor NE : Anemia: a modifiable risk factor for heart disease. Introduction. Rev Cardiovasc Med 2005; 6 ( Suppl 3): S1–S3.
Lameire N, Adam A, Becker CR, et al: Baseline renal function screening. Am J Cardiol 2006; 98 ( 6A): 21K–26K.
Little WC, Brucks S : Therapy for diastolic heart failure. Prog Cardiovasc Dis 2005; 47: 380–388.
Little WC, Downes TR : Clinical evaluation of left ventricular diastolic performance. Prog Cardiovasc Dis 1990; 32: 273–290.
Little WC, Warner JG Jr, Rankin KM, et al: Evaluation of left ventricular diastolic function from the pattern of left ventricular filling. Clin Cardiol 1998; 21: 5–9.
Nishimura RA, Tajik AJ : Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta stone. J Am Coll Cardiol 1997; 30: 8–18.
Singh JP, Larson MG, Manolio TA, et al: Blood pressure response during treadmill testing as a risk factor for new-onset hypertension: the Framingham Heart Study. Circulation 1999; 99: 1831–1836.
Matthews CE, Pate PR, Jackson KL, et al: Exaggerated blood pressure response to dynamic exercise and risk of future hypertension. J Clin Epidemiol 1998; 51: 29–35.
Little WC, Kitzman DW, Cheng CP : Diastolic dysfunction as a cause of exercise intolerance. Heart Fail Rev 2000; 5: 301–306.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Takamura, T., Onishi, K., Sugimoto, T. et al. Patients with a Hypertensive Response to Exercise Have Impaired Left Ventricular Diastolic Function. Hypertens Res 31, 257–263 (2008). https://doi.org/10.1291/hypres.31.257
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.31.257