Abstract 2200: Exaggerated Exercise Blood Pressure Response Is Accompanied by a State of Pronounced Inflammatory Activation, Impaired Thrombosis/Fibrinolysis System and Arterial Stiffening in Essential Hypertension
There are conflicting data regarding the cardiovascular prognostic value of hypertensive response to exercise (HRE), while low-grade inflammation, arterial stiffness and impaired fibrinolysis are associated with atherosclerosis progression. High-sensitivity C-reactive protein (hs-CRP), plasminogen-activator inhibitor type 1 (PAI-1) and arterial stiffening may be correlated with HRE in essential hypertensives. 84 newly diagnosed untreated non-diabetic subjects 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 in women) and to those without HRE (n=60). Moreover, in all subjects venous blood samples were drawn for estimation of hs-CRP and PAI-1 levels, whereas arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method (Complior SP). Patients with HRE compared to those without HRE were older (56±9 vs 50±9 years, p<0.05) and had greater 24-h systolic BP (138±14 vs 131±12 mmHg, p<0.05). Although groups did not differ regarding metabolic profile and left ventricular mass index (p=NS for all), patients with HRE as compared to those without HRE exhibited higher levels of PWV (8.7±1.6 vs 7.7±1.3 m/sec, p<0.005), hs-CRP (5.1±1.2 vs 2.1±0.8 mg/l, p<0.0001) and PAI-1 (38.6±8.5 vs 18.9±2.6 ng/ml, p<0.05). 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<0.005) and hs-CRP (r=0.439, p<0.0001), whereas there was no association with PAI-1 levels (p=NS). By analysis of covariance it was revealed that PWV, hs-CRP and PAI-1 values remained significantly different between groups after adjustment for confounders (p<0.05). Hypertensives with an HRE exhibit augmented hs-CRP, PAI-1 and PWV values. These findings suggest that impaired thrombosis/fibrinolysis system, arterial stiffening and microinflammation may be mechanisms that contribute to exercise hypertension and increase risk in this setting.