Ps-C25-6: Hypertensive Response to Exercise as Predictor for Development of Essential Hypertension and Hospitalization Due to Major Adverse Cardiac Event

Abstract

Objective:The aim of this study was to determine the structural and metabolic factors associated with hypertensive response to exercise (HRE) in non hypertensive patients and role of HRE in predict development of essential hypertension during follow-up and predict hospitalization due to major adverse cardiac event (MACE).Design and method:This study was a cross-sectional retrospective study using cardiac treadmill stress test (TST) data at Sanglah General Hospital, Bali from 2016–2020. Data analysis used SPSS version 21. Subjects were divided into positive HRE and negative HRE. Pearson-chi square test and Mann-Whitney test were used to compare categorical variables based on age, gender, smoking status, nutritional status, alcohol status, dyslipidemia, type 2 diabetes mellitus (T2DM), HbA1C, total cholesterol, LDL, HDL, triglycerides, history of kidney disease, and mean echocardiographic parameters based on the presence of HRE. Development of essential hypertension during follow up and history of hospitalization after cardiac TST due to MACE until April 2022 based on the presence of HRE was evaluated using receiver operating characteristics.Results:We evaluated 202 non hypertensive patients (47,1% with HRE) who underwent cardiac TST. During follow up, 19.8% experienced hospitalization and 26.1% developed hypertension. Obesity (PR1.727; 95%CI = 1.235–2.413), smoking status (PR1.773; 95%CI = 1.170–2.687), T2DM (PR2.29; 95%CI = 1.16–3.37), HbA1C (PR3.13; 95%CI = 2.31–4.22), high LDL level (PR1.853, 95%CI = 1.229–2.794) and history of kidney disease (PR1.985; 95%CI = 1.478–2.665), were significantly associated with positive HRE (all p-value < 0.05). Regarding the clinical outcomes, patients with HRE were associated with an increased risk of developing essential hypertension (PR1.72; 95%CI = 1.235–2.413 p = 0.05) and hospitalization due to MACE (OR2.27, 95% CI = 1.62–3.16, p = 0.0001) during follow up, with sensitivity of 76.7% and specificity of 93.6%. Subjects with HRE had higher LV mass index (82.34 ± 15.05 vs 70.62 ± 9.76), higher E/E ratio (16.31 ± 2.95 vs 16.01 ± 13.23), higher LAVI (39.75 ± 15.21 vs 34.27 ± 11.15) with all p-value were < 0.05.Conclusions:Patients with impaired cardiometabolic and the presence of cardiac remodeling commonly have HRE that could be detected by cardiac TST examination, which may predict the development of essential hypertension and major adverse cardiac events in the future.