Ambulatory blood pressure and Doppler echocardiographic indexes of borderline hypertensive men presenting an exaggerated blood pressure response during dynamic exercise

Borderline hypertension (BH) has been associated with an exaggerated blood pressure (BP) response during laboratory stressors. However, the incidence of target organ damage in this condition and its relation to BP hyperreactivity is an unsettled issue. Thus, we assessed the Doppler echocardiographic profile of a group of BH men (N = 36) according to office BP measurements with exaggerated BP in the cycloergometric test. A group of normotensive men (NT, N = 36) with a normal BP response during the cycloergometric test was used as control. To assess vascular function and reactivity, all subjects were submitted to the cold pressor test. Before Doppler echocardiography, the BP profile of all subjects was evaluated by 24-h ambulatory BP monitoring. All subjects from the NT group presented normal monitored levels of BP. In contrast, 19 subjects from the original BH group presented normal monitored BP levels and 17 presented elevated monitored BP levels. In the NT group all Doppler echocardiographic indexes were normal. All subjects from the original BH group presented normal left ventricular mass and geometrical pattern. However, in the subjects with elevated monitored BP levels, fractional shortening was greater, isovolumetric relaxation time longer, and early to late flow velocity ratio was reduced in relation to subjects from the original BH group with normal monitored BP levels (P<0.05). These subjects also presented an exaggerated BP response during the cold pressor test. These results support the notion of an integrated pattern of cardiac and vascular adaptation during the development of hypertension

Arterial pressure reactivity to experimental stress tests in normotensive humans with arterial pressure hyperreactivity during submaximal exercise

Normotensive individuals with a sedentary life style and low occupational physical activity presenting an elevated arterial pressure response during the bicycle exercise test (systolic pressure, SP, > or = 220 and/or an increase in diastolic pressure, delta DP, > or = 15 mmHg) (hyperreactive group, HG, N = 45) were submitted to the following tests: isometric hand-grip, cold pressor, mathematical calculation and word/color conflict (Stroop). Their results were compared with those obtained for a control group of normotensive individuals with normal response during the bicycle exercise test (SP < 220 and delta DP < 15 mmHg) (normoreactive group, NG, N = 45). In the isometric hand-grip a differentiated increase of SP and DP (P < 0.01) was observed in the HG as compared with the NG. In the cold pressor test a different increase of SP and DP was also demonstrable (P < 0.05). The mathematical and word/color conflict tests produced highly differentiated responses of SP (P < 0.01) and DP (P < 0.05) between groups. These results indicate that HG individuals present an arterial pressure response significantly higher than the NG during stress tests. Although the elevated levels of arterial pressure used for group selection may have contributed to the formation of an indiscriminate arterial pressure hyperreactive group, the results, taken as a whole, suggest that hyperreactive individuals present higher levels of sympathetic drive and/or an increased response of the cardiovascular system to adrenergic stimulation.