Abstract 15011: Exaggerated Exercise Blood Pressure Response Is Associated With a State of Arterial stiffening, Augmented Asymmetric Dimethylarginine and Osteoprotegerin Levels in Essential Hypertensive Subjects
Introduction: A hypertensive response to exercise (HRE) is associated with high cardiovascular risk, while elevated levels of asymmetric dimethylarginine (ADMA) and osteoprotegerin (OPG) are related to atherosclerosis progression.
Hypothesis: In essential hypertension, a HRE may be associated with ADMA, OPG and arterial stiffness.
Methods: 240 newly diagnosed never treated non-diabetics with stage I to II essential hypertension [155 men, mean age=51 years, office blood pressure (BP)=150/96 mmHg] with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n=70) (peak exercise systolic BP ≥210mmHg in men and ≥190 mmHg in women) and those without HRE (n=170). In all subjects arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values, by means of a computerized method (Complior SP) and venous blood samples were drawn for estimation of ADMA and OPG concentrations.
Results: Patients with HRE compared to those without HRE had greater 24-h systolic BP (143±9 vs 131±8 mmHg, p<0.05), while did not differ regarding metabolic profile and left ventricular mass index (p=NS). Patients with HRE as compared to those without HRE exhibited greater levels of ADMA (0.63±0.04 vs 0.52±0.05 μmol/l, p<0.0001), OPG (5.4±0.1 vs 4.1±0.5 pmol/l, p<0.0001) and PWV (8.9±1.7 vs 7.5±0.9 m/sec, p<0.0001), independently of confounders. In the total population, peak exercise systolic BP was related to 24-h systolic BP (r=0.249, p<0.05), PWV (r=0.278, p=0.003), ADMA (r=0.260, p=0.007) and OPG (r=0.214, p<0.05). Regarding OPG, it was associated with 24-h systolic BP (r=0.285, p<0.0001), ADMA (r=0.284, p<0.05) and PWV (r=0.424, p<0.0001). Multiple regression analysis showed that 24-h systolic BP (b=0.216, p=0.003), ADMA (b=0.225, p=0.006) and OPG (b=0.188, p<0.05) were independent predictors of peak exercise systolic BP.
Conclusions: In essential hypertension, a HRE is accompanied by a state of increased arterial stiffening, endothelial dysregulation and progressive atherosclerosis, as reflected by PWV, ADMA and OPG values. The interrelationships of ADMA and OPG with exercise BP response and stiffness, further support that diffuse vascular dysfunction contributes to HRE-related risk in hypertension.
- © 2010 by American Heart Association, Inc.