ABSTRACT
OBJECTIVES: To investigate the relationship between arterial blood pressure, left ventricular mass, diastolic filling and maximal exercise capacity in patients with newly diagnosed essential hypertension. DESIGN: Asymptomatic untreated patients with office blood pressure > 140/90 mmHg were studied prospectively after exclusion of associated disease. METHODS: Twenty consecutive white patients (14 male, 6 female; age 43 +/- 12 years) with office blood pressure 164 +/- 23/103 +/- 10 mmHg, mean 24-h ambulatory blood pressure 142 +/- 25/89 +/- 15 mmHg and normal systolic cardiac function underwent an echocardiographic examination to determine left ventricular mass and diastolic filling parameters and performed a bicycle ergometer test to determine maximal voluntary exercise capacity. RESULTS: In single regression analysis exercise time and maximal oxygen uptake were related to sex and age. A multiple regression showed that only age was related to exercise capacity, however. On subgroup analysis of male patients between 30 and 50 years (n = 10), exercise time (659 +/- 134 s) was significantly inversely related to mean 24-h ambulatory diastolic blood pressure (92 +/- 11 mmHg) (r = -0.67; p = 0.03) and positively to diastolic filling expressed as ratio of peak early to peak atrial filling velocity (Emax/Amax ratio; 1.34 +/- 0.40) (r = 0.65; p = 0.04) or as ratio of velocity time integral (VTI) of early filling phase to VTI of atrial filling phase (VTIE/VTIA ratio; 1.94 +/- 0.72) (r = 0.02). Maximal oxygen consumption (22.3 +/- 4.1 ml/kg/min) was significantly inversely correlated with mean 24-h ambulatory diastolic blood pressure (r = -0.67; p = 0.03), mean 24-h ambulatory systolic blood pressure (147 +/- 25 mmHg) (r = -0.82; p < 0.01), left ventricular mass (312 +/- 143 g) (r = -0.86; p < 0.01), left ventricular mass index (135 +/- 41 g/m2) (r = -0.76, p = 0.01) and positively with diastolic filling expressed as Emax/Amax ratio (r = 0.71; p = 0.02) or as VTIE/VTIA ratio (r = 0.70; p = 0.02). CONCLUSION: This study shows the important interrelation between blood pressure, cardiac mass, diastolic filling and exercise capacity. High blood pressure entrains a larger cardiac mass but slows cardiac filling and decreases exercise capacity.
