Abstract 2606: Exaggerated Blood Pressure Response During Treadmill Test is Associated With Arterial Stiffening and Increased Urinary Albumin Excretion in Essential Hypertensive Subjects: Identifying a State of Diffuse Atherosclerosis
Introduction: The data regarding the association of a hypertensive response to exercise (HRE) with cardiovascular risk remain controversial, whereas both urinary albumin excretion and arterial stiffening are associated with atherosclerosis progression.
Hypothesis: Increased urinary albumin excretion, expressed as the albumin to creatinine ratio (ACR), and pronounced arterial stiffness may be related to HRE in essential hypertensives.
Methods: 84 newly diagnosed untreated non-diabetic patients with stage I to II essential hypertension [58 men, mean age=52 years, office blood pressure (BP)= 145/93 mmHg] with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n=24) (peak systolic BP >210mmHg in men and >190 mmHg in women) and to those without HRE (n=60). Moreover, in all subjects ACR values were determined as the mean of two non-consecutive morning spot urine samples and arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method (Complior SP).
Results: Patients with HRE compared to those without HRE were older (56±9 vs 50±9 years, p<0.05), had greater 24-h systolic BP (138±14 vs 131±12 mmHg, p<0.05), while did not differ regarding metabolic profile, left ventricular mass index and relative wall thickness (p=NS for all). Moreover, patients with HRE as compared to those without HRE exhibited higher levels of ACR (71.9±18 vs 14.2±2.6 mg/g, p<0.0001), and PWV (8.7±1.6 vs 7.7±1.3 m/sec, p<0.005). In the total population, peak systolic BP was related to 24-h systolic BP (r=0.238, p<0.05), PWV (r=0.288, p<0.05) and ACR (0.474, p<0.0001). By analysis of covariance it was revealed that ACR and PWV values remained significantly different between groups after adjustment for confounding factors (p<0.05).
Conclusions: In the setting of essential hypertension, an HRE is associated with augmented ACR and accelerated arterial stiffening, reflecting diverse pro-atherosclerotic pathways. These findings suggest that HRE may be a useful tool in identifying hypertensives at high cardiovascular risk.