Relation of stress testing and ambulatory blood pressure to hypertensive cardiac damage

Abstract

In essential hypertension, the severity of cardiovascular damage is only weakly related to clinic blood pressure (BP), whereas a better relationship seems to exist with BP recorded during stressful situations. The present study compared BP levels measured during laboratory stress testing and 24-h ambulatory monitoring with regard to their relationship with cardiac end-organ involvement. BP recorded during a mental and a physical challenge and during 24-h ambulatory monitoring was related to Doppler echocardiography characteristics of left ventricular structure and filling in 63 untreated essential hypertensives and in 32 healthy subjects. In the hypertensive group, only a weak relationship was observed between left ventricular mass and clinic BP; the strength of this association was not improved by BP measured during mental task and cycle ergometry, and was slightly but not significantly higher for BP recorded during ambulatory monitoring. In multivariate analysis, left ventricular mass was independently predicted by stroke index and 24-h systolic BP. Among the different pressure measures, 24-h, daytime, and nighttime BPs bore the only significant relation to relative wall thickness. In the normotensive group, no significant relationship was observed between left ventricular mass and different measures of BP. Doppler indexes of left ventricular diastolic filling did not significantly relate to any BP measurement in the hypertensive group, and generally bore a significant inverse relationship to various BP recordings in the normotensive group. To summarize, stress testing BP does not help in identifying hypertensive patients with increased left ventricular mass.

Association between Altered Circadian Blood Pressure Profile and Cardiac End-Organ Damage in Patients with Renovascular Hypertension

“…Moreover, both experimental and human studies have demonstrated that repeated exposures to intermittent BP elevations induced by environmental stressors could importantly contribute to cardiac hypertrophy [18, 19]. In this regard, our findings seem in keeping with those of previous reports and suggest that increased BP levels and variability during daily activities might be involved in the increased prevalence of left ventricular hypertrophy observed in RVH.…”

Exercise blood pressure response is related to left ventricular mass

“…Several studies have addressed the importance of BP responses to exercise in relation to LV mass. While some studies have suggested that exercise BP is a good predictor of increased LV mass, 12,13 other studies reported a lack of an independent relation [14][15][16][17] or a marginal association 18 between exercise BP and LV mass. However, previous reports rarely considered other parameters that may also explain the relation between the exercise BP and LV mass.…”

Relation between exercise central haemodynamic response and resting cardiac structure and function in young healthy men

“…Indeed, the peripheral exercise BP response predicts cardiovascular morbidity and mortality to a greater extent than resting BP in older hypertensive adults (Mundal et al, 1996;Kurl et al, 2001). However, in younger adults, the brachial BP response to exercise does not consistently associate with LV mass or LV systolic function (Lauer et al, 1992;Fagard et al, 1995;Cardillo et al, 1996;Markovitz et al, 1996;Takamura et al, 2008). Thus, the use of central exercise haemodynamic load may be insightful when examining associations with potential target organ damage in younger adults.…”