An exaggerated blood pressure response to exercise is associated with subclinical myocardial dysfunction in normotensive individuals

Abstract

Normotensive individuals with an exaggerated BP response to exercise exhibit impairment in longitudinal myocardial function. Even without apparent hypertension, an exaggerated BP response could cause repeated increases in afterload and result in subclinical myocardial dysfunction.

Clinical importance of detecting exaggerated blood pressure response to exercise on antihypertensive therapy

“…Therefore, regression of LVH is one of the main goals of antihypertensive treatment in patients with hypertension. Ex-BP has been suggested to be linked to various mechanisms, including vascular function,14 activities of the sympathetic nervous system15 16 and the renin-angiotensin-aldosterone system 17 18. Although previous studies have investigated the relationship between Ex-BP and LVM in a cross-sectional study, controversy still exists.…”

Adult echocardiographic nomograms: overview, critical review and creation of a software for automatic, fast and easy calculation of normal values

“…Despite a good representation of different geographic areas with data coming from Europe (60,61,63,67,77,78,95), North America (63,67,69,70,74) and Asia (79), nomograms were constructed by using limited sample sizes with only two studies (61,68) having >300 subjects and one having 1266 subjects (66), the latter evaluated only LV longitudinal strain (ε). Data on LA ε are also extremely limited with only three studies having >100 subjects (71,84,94) and the widest population of 329 subjects (68). To overcome the lack of data, both for LVε (65) and for LA strain (65) metaanalytic works have been performed, despite the known limitations (6,10).…”

“…Tacking quality was accomplished by using automated method (i.e., the automated QT score) (67,77) or more often subjectively (60,66,73,94). As summarised in Table S1 different vendors have been used to acquire measurements, despite GE was mostly employed with few exception (68,79) and usually vendor specific software has been employed for data analysis with a few exceptions (66,70,95).…”

“…For longitudinal LV ε the 16 segments model excluding the apex has been generally used (60,61,66) while in some works whether the apex was excluded from calculation was not specified (67). The LA was analyzed by using a single projection (i.e., 4-chamber view, 6 segments scheme) (70,79), two projections (4-and 2-chamber views) (68,69,77,94), considering 12 segments (68,77,94), or 14 segments (69), or even by evaluating three projections (2-and 4-chamber view and long axis view, 15 segments scheme) (74). Notably, 2-chamber average peak atrial longitudinal ε (PALS) was significantly higher than in 4-chamber (P<0.0001) measurements, whereas there was no difference found between 2-and 4-chamber average time to peak longitudinal strain (P=0.93) (77).…”

“…In adults instead fixed rather than subject specific echocardiographic cut-off values have been generally employed for decades to grade disease severity and pose surgical indications (11,12). However, cardiac dimensions and functional indexes change with increasing age also in the adult population and substantially differ according to gender and body size (88)(89)(90)(91)(92)(93)(94)(95)(96). Over the last few years , there has been a crescent call for patients specific rather than generic threshold values , leading multiple authors to publish echocardiographic normative data .…”