Abstract 10211: Exaggerated Exercise Blood Pressure Response is Related to Increased Arterial Stiffness, Asymmetric Dimethylarginine and Osteoprotegerin 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 related to ADMA, OPG and arterial stiffness.
Methods: Our population of 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) was divided into those with HRE (n=70) (peak exercise systolic BP >or=210mmHg in men and >or=190 mmHg in women) and those without HRE (n=170). Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values.
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 μ mol/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), male sex (b=0.270, p<0.05), 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. The interrelationships of ADMA and OPG with exercise BP response support that diffuse vascular dysfunction contributes to HRE-related risk in hypertension.
- © 2011 by American Heart Association, Inc.