Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension

Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension.

Relationship between Exercise-induced Blood Pressure Response and Left Ventricular Hypertrophy in Patients with Hypertension

BACKGROUND: In hypertensive patients, who show abnormal blood pressure(BP) response during exercise, more excessive blood pressure response may occur in the daily life, and cause end organ damage. However, previous studies about exaggerated BP response during exercise were not enough to investigate its significance and role in left ventricular hypertrophy. The purpose of this study was to determine the relation between exaggerated BP response during exercise and left ventricular hypertrophy. METHODS: The treadmill exercise test and echocardiography were performed in 117 patients with hypertension. Sixty six patients showed normal BP response, fifty one patients showed exaggerated BP response. Exaggerated BP response was defined as elevation of peak exercise systolic BP over 210 mmHg or >10 mmHg elevation of peak exercise diastolic BP from baseline. The correlation between BP response and left ventricular mass index were evaluated in two groups. RESULT: The results were as follows; 1. The peak systolic and diastolic BP were significantly higher in patients with exaggerated BP response than that in patients with normal BP response (p<0.05). 2. There was weakly significant relation between peak exercise systolic BP and left ventricular hypertrophy, but diastolic BP showed no significant correlation with left ventricular hypertrophy. 3. The left ventricular mass index was significantly increased in patients with exaggerated BP response (normal BP response: 12025 gm/m2, exaggerated BP response: 16946 gm/m2 , p=0.04). CONCLUSION: These results indicate that, as compared with resting BP, exercise BP response seems to be important in the treatment of hypertension and more strict blood pressure control may be needed in hypertensive patients with exaggerated BP response. Further study is needed to understand the significance of exaggerated BP response in hypertension.