ABSTRACT
Objective:To examine the effects of individualized exercise rehabilitation prescriptions based on cardiopulmonary exercise tests on ambulatory blood pressure and cardiopulmonary function in elderly hypertension patients.Methods:This was a prospective randomized controlled study.Sixty essential hypertension patients hospitalized in our hospital from January 2020 to November 2020 and on regular antihypertensive medication were selected and divided using a random number table into the control group(30 cases)and the study group(30 cases). The control group received only conventional medication and the study group conducted individualized exercise rehabilitation in addition to medication, with no adjustment in anti-hypertensive medication for patients in either group.All enrolled patients underwent cardiopulmonary exercise testing and ambulatory blood pressure monitoring before treatment and 12 weeks after treatment.Changes in blood pressure and cardiopulmonary function in the two groups were compared.Results:Compared with the control group, the study group recorded reductions in the 24-hour average systolic blood pressure(135.6±8.7 mmHg vs.141.8±6.3 mmHg), 24-hour average diastolic blood pressure(79.3±9.4 mmHg vs.85.1±6.7 mmHg), daytime average systolic blood pressure(136.4±7.8 mmHg vs.140.2±6.6 mmHg), daytime average diastolic blood pressure(78.2±7.6 mmHg vs.84.4±7.2 mmHg), night-time average systolic blood pressure(125.0±9.6 mmHg vs.129.7±7.9 mmHg), and night-time average diastolic blood pressure(76.6±7.6 mmHg vs.84.5±6.7 mmHg)after 12 weeks of exercise( P<0.05 for all). Compared with pre-exercise levels, the study group achieved decreases in body mass index, resting heart rate, resting systolic blood pressure, resting diastolic blood pressure, peak systolic blood pressure, peak diastolic blood pressure( P<0.05 for all), and increases in maximum metabolic equivalent, peak oxygen uptake, maximum power and peak heart rate( P<0.05 for all), while the control group saw decreases in resting heart rate and resting diastolic blood pressure( P<0.05). After 12 weeks, the study group had lower levels than the control group in body mass index(24.5±2.0 kg/m 2vs.26.7±2.2 kg/m 2), resting systolic blood pressure(133.8±10.8 mmHg vs.139.3±9.0 mmHg)and resting diastolic blood pressure(79.4±8.0 mmHg vs.84.9±9.3 mmHg)( P<0.05)and higher levels in maximum metabolic equivalent(6.0±0.6 vs.5.2±1.1), peak oxygen uptake(22.0±2.7 ml·min -1·kg -1vs.20.3±3.7 ml·min -1·kg -1), maximum power(124.3±19.9 W vs.112.4±25.1 W)and peak heart rate(130.1±15.5 times/min vs.122.9±11.7 times/min)( P<0.05). Conclusions:Compared with antihypertensive drugs alone, the addition of individualized exercise prescriptions for rehabilitation based on cardiopulmonary exercise tests can effectively reduce blood pressure, improve cardiopulmonary function, and enhance exercise endurance and quality of life for elderly hypertension patients.
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Objective:To analyze the correlation between serum insulin-like growth factor binding protein-7(IGFBP7)levels and left ventricular diastolic function and exercise capacity in elderly heart failure patients with preserved ejection fraction(HFpEF).Methods:This was a prospective study.A total of 40 elderly patients in our hospital with HFpEF were selected as the HFpEF group, and 20 patients with normal left ventricular diastolic and systolic function were selected as the control group.Serum levels of IGFBP7 were measured by enzyme linked immunosorbent assay, while N-terminal pro-brain natriuretic peptide(NT-proBNP)was measured by chemi-lumin escence assay.The levels of biomarkers were compared between the two groups.Diastolic function was assessed by transthoracic echocardiography, exercise tolerance was assessed by cardiopulmonary exercise testing(CPET).Results:The levels of IGFBP7 in HFpEF group was significantly higher than control group[median value, 59.4 ng/L(52.2-70.6 ng/L) vs.50.8 ng/L(42.0-55.2 ng/L), P<0.01]. In multivariable analysis, NT-proBNP and IGFBP7 were independently associated with HFpEF(all P<0.05). The area under receiver operating characteristic curve of IGFBP7 and NT-proBNP for detecting HFpEF were 0.778 and 0.820, respectively(all P<0.01). Higher IGFBP7 was modestly correlated with NT-proBNP, left atrial volume index, early diastole velocity(E), E/peak late diastolic velocity(E/A), early mitral inflow velocity/annular diastolic velocity(E/e′), estimated right ventricular systolic pressure, peak oxygen uptake(VO 2 peak), anaerobic threshold and minute ventilation/earbon dioxide production(VE/VCO 2)(all P<0.05). Conclusions:In elderly patients with HFpEF, IGFBP7 may be a novel biomarker of diastolic function and exercise capacity.
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Objective To examine the features and clinical significance of cardiopulmonary exercise testing(CPET)in elderly patients with coronary heart disease.Methods A retrospective study was conducted at the Fifth Affiliated Hospital of Zhengzhou University from September 2015 to August 2017.Fifty-nine elderly inpatients who had undergone coronary angiography and CPET were enrolled.The mean age was 61.5 years,and there were 48 males and 11 females.Based on the results of coronary angiography,patients were divided into a coronary heart disease(CAD)group(n =40)and a non-CAD group (n =19).Meanwhile,according to the degree of coronary stenosis assessed by angiography,the CAD group was further divided into two subgroups (Group A:coronary stenosis,50 ％ -70％,n =25;Group B:coronary stenosis,＞ 70％,n =15).All results of CPET were compared between the groups.Results Patients in the CAD group were significantly associated with a lower anaerobic threshold(855.8±207.0)ml/min vs.(976.5±231.8)ml/min,a lower peak VO2 (1 371.5±388.8)ml/min vs.(1652.8±435.5)ml/min,a lower percentage of peak VO2 (18.3±4.7)ml · min-1 ·kg-1 vs.(22.0±4.4)ml · min 1 · kg-1,a lower peak O2-pulse(65.6±14.8)％ vs.(85.5±14.9)％ and a lower △VO2/△WR slope to expected value(8.0 ± 1.1)ml · min-1 · W-1 vs.(9.1 ± 1.5)ml ·min-1 · W 1,compared with those in the non-CAD group(all P＜0.05).However,there was no significant difference in other indexes between the groups.Furthermore,in the CAD group,△VO2/△WRall-Ex,△VO2/△WR＞AT and △VO2/△WRRatio to expected value were lower in Group B(7.5 ± 1.3vs.8.3±1.0,t=2.317,P=0.026),(6.2±1.9 vs.7.6±1.2,t=2.815,P=0.008)and(0.7±0.2vs.0.9±0.1,t=2.957,P =0.005).There was no difference in △VO2/△WR＜AT (P＞0.05).Conclusions Exercise tolerance is lower in elderly CAD patients than those without CAD,and △VO2/△WR is decreased during the process of exercise,especially after the AT,which may be associated with low cardiac output due to left ventricular myocardial isehemia.This finding suggests that CPET can provide evidence of ischemia in patients with coronary heart disease and is valuable for the development of diagnostic and therapeutic strategies.