Prognostic Value of Invasive Hemodynamic Measurements at Rest and During Exercise in Hypertensive Men

Abstract

In 1994, we ascertained the outcome of 143 hypertensive men in whom invasive hemodynamic measurements were performed at rest and during graded bicycle exercise during the period 1972-1982 to assess (1) which of the hemodynamic components of blood pressure is associated with the incidence of cardiovascular events and total mortality, and (2) whether the hemodynamic response to dynamic exercise adds prognostic precision to the data at rest. During 2186 patient years of follow-up, 38 patients suffered at least one fatal or nonfatal cardiovascular event and 17 patients died. Cox regression analysis showed that systolic pressure and systemic vascular resistance measured at rest, during submaximal exercise (50 W), and at peak effort were significant (P < .01) predictors of the age-adjusted incidence of cardiovascular events and total mortality. However, exercise blood pressure did not significantly predict the incidence of cardiovascular events over and above pressure at rest; by contrast, exercise systemic vascular resistance added prognostic precision to vascular resistance at rest (P < .01). As for total mortality, systolic pressure and systemic vascular resistance at peak exercise carried prognostic information that was independent of the results at rest (P < .05); this was not the case for measurements during submaximal exercise. We conclude that the prognostic importance of blood pressure is related to systemic vascular resistance. The prognostic precision of exercise pressure, on top of pressure at rest, is limited. Exercise systemic vascular resistance, however, provides prognostic information beyond that available from measurements at rest, particularly for the incidence of cardiovascular events.

Exercise blood pressure response is related to left ventricular mass

“…Studies that reported positive associations between LV mass and exercise BP included only men, 7,8 while other studies that did not show such an association included both genders. 9,10 In our study, the correlation between exercise SBP and LV mass was stronger in men than in women. While the relation of exercise SBP and LV mass was not significantly different between genders in multivariate model, the bivariate correlations were statistically significant in men but not in women.…”

“…4 An exaggerated BP response to exercise is a known marker for future hypertension [5][6][7][8] and increased mortality. [9][10][11] Since BP during exercise reflects cardiac load during a period of high demand for cardiac output, it may be a more sensitive predictor of LV mass than resting BP. Several studies have addressed the importance of BP responses to exercise in relation to LV mass.…”

Value of Noninvasive Hemodynamics to Achieve Blood Pressure Control in Hypertensive Subjects

“…Improvements in vascular resistance may result in greater benefits in reducing cardiovascular risk than improvement in BP alone, 24 and differences in SVRI at the same BP may explain poorer prognosis for men versus women 25 and black versus nonblack patients. 26 Hemodynamics are also known to change with age.…”

Wytyczne ESH/ESC dotyczące postępowania w nadciśnieniu tętniczym w 2013 roku

“…Wyniki badań dotyczących prognostycznego znaczenia BP podczas wysiłku fizycznego również nie są zgodne [125], co może wynikać z tego, że podczas dynamicznego wysiłku fizycznego 2 składowe hemodynamiczne BP ulegają zmianom w przeciwnych kierunkach: systemowy opór naczyniowy zmniejsza się, natomiast pojemność minutowa wzrasta. Prawdopodobnie decydującym czynnikiem prognostycznym jest osłabienie zmniejszenia systemowego oporu naczyniowego podczas wysiłku, które wynika z patofizjologicznych zmian strukturalnych w tętnicach i tętniczkach [123,129]. To, czy wspomniane upośledzenie rozkurczu tętnic będzie prowadzić do nadmiernego wzrostu BP, czy też nie, może przynajmniej częściowo zależeć od pojemności minutowej.…”

“…W przypadku prawidłowego BP w spoczynku nadciś- nienie wywołane wysiłkiem można uważać za wskazanie do ABPM ze względu na jego związek z nadciśnieniem zamaskowanym [131]. Jeśli natomiast nadciśnienie wiąże się z dysfunkcją serca i zmniejszeniem wzrostu pojemności minutowej w odpowiedzi na wysiłek, to BP podczas wysiłku może tracić znaczenie prognostyczne [129]. Należy wreszcie zauważyć, że wyższe BP podczas wysiłku może się nawet wiązać z lepszym rokowaniem, np.…”