Peripheral Vascular Resistance Limits Exercise Functional Capacity of Mild Hypertensives

Abstract

To evaluate the physiological basis for suboptimal peak exercise oxygen consumption (VO2p) observed in the early stage of hypertension, 25 WHO Stage I hypertensive men with normal left ventricular mass and 10 healthy control subjects of equivalent age underwent the maximal cardiopulmonary exercise test with contemporary measurement of cardiac output with Tc99m angiocardiography. At peak exercise hypertensive patients had lower VO2p (p < 0.045) and cardiac output (p < 0.014) and higher vascular resistance (p < 0.010) than controls. At multiple regression analysis VO2 was positively related to cardiac output in controls (r = 0.80, p < 0.02), whereas in hypertensives the best (negative) correlation was observed with peripheral vascular resistance (r = -0.72, p < 0.04). Thus reduced cardiopulmonary function during physical exercise in hypertensives seems to be mainly related to impaired peripheral vascular autoregulation.

Testosterone replacement increases vasodilatory reserve in androgen-deficient female rats

“…Because endogenous levels of T correlate with exercise capacity in postmenopausal women (19), these changes suggest that physiological levels of T are beneficial to heart circulation and contribute to a heart that can more readily adapt to physical and metabolic demands. Indeed, impaired peripheral vascular autoregulation has been correlated with reduced exercise capacity (20).…”

Arterial Hypertension and Cardiopulmonary Function: The Value of a Combined Cardiopulmonary and Echocardiography Stress Test

“…CPET, baseline echocardiography To assess the relationship between impaired left ventricular deformation and exercise capacity in patients with AH STE-derived parameters of myocardial deformation significantly decreased in patients with untreated AH and related with peak VO 2 ( p < 0.05). Modesti et al, 1999 [ 84 ] 25 pts with AH and no LVH + 10 matched controls CPET, baseline echocardiography, angiocardioscintigraphy To evaluate the role of systemic vascular resistance in effort intolerance Lower peak VO 2 ( p < 0.045), higher vascular resistance ( p < 0.010) in AH vs controls. Significant correlation between systemic vascular resistance and peak VO 2 ( r = -0.72, p<0.04).…”

“…Invasive hemodynamic assessment of arterial function at rest and during exercise confirmed those results, unmasking significant exercise-induced impairment in arterial compliance and vasodilatory response to nitrate infusion in HFpEF and AH [ 9 , 83 ]. Such alterations can lead to a reduced peak VO 2 , an earlier AT and a steeper VCO 2 /VO 2 in hypertensive patients [ 84 , 85 ]. It has been recently observed that, despite peak VO2 appears more severely impaired in hypertensive subjects with HFpEF than in isolated AH, the two populations share similar signs of low peripheral oxygen extraction in terms of impaired AVO 2 diff [ 9 ].…”