Why is functional capacity decreased in hypertensive patients? From mechanisms to clinical studies

Abstract

The influence of arterial hypertension on functional capacity is poorly understood. Studies have shown that peak oxygen consumption has been reduced in hypertensive patients, but the mechanisms are unclear. Left ventricular systolic and diastolic dysfunction, as well as left ventricular hypertrophy, are associated with lower functional capacity in patients with arterial hypertension. Furthermore, some investigations found a significant relationship between right ventricular systolic function and functional capacity in the general population. The aim of this review was to summarize current knowledge about the mechanisms of reduced functional capacity in hypertensive patients, including the impact of systemic and pulmonary circulations, as well as the influence of the left and right ventricle on oxygen consumption. Additionally, we reviewed all clinical studies regarding functional capacity in the population with arterial hypertension.

Influence of circadian blood pressure patterns and cardiopulmonary functional capacity in hypertensive patients

“…Moreover, reverse BP dipping pattern was positively associated with increased ventilation/carbon dioxide. This might be explained by changes in pulmonary vasculature and cardiac dysfunction induced by arterial hypertension . Studies showed that ventilation/carbon dioxide slope was the strongest predictor of mortality and severe complications after lung resection, and superior predictor to the oxygen uptake efficiency slope in patients with heart failure …”

“…This might be explained by changes in pulmonary vasculature and cardiac dysfunction induced by arterial hypertension. 5 Studies showed that ventilation/carbon dioxide slope was the strongest predictor of mortality and severe complications after lung resection, 21 and superior predictor to the oxygen uptake efficiency slope in patients with heart failure. 22 TA B L E 4 The association between demographic and clinical with parameters of cardiopulmonary exercise testing (correlation and multivariate regression analyses)…”

“…Furthermore, we showed significant negative correlation between blood pressure (BP) and peak VO2, as well as between left ventricular remodeling and peak VO2 . The mechanisms of the relationship between BP and functional capacity are still largely speculative …”

Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful?

“…Only recently have the studies that investigate RV mechanics in hypertensive patients appeared. They have shown significant deterioration of RV longitudinal deformation and revealed the association between RV longitudinal strain and functional capacity in hypertensive patients . Furthermore, the studies have detected that RV longitudinal strain represents the strongest independent predictor of RV function, as well as the strong relationship between RV longitudinal strain and cardiovascular mortality and morbidity in a wide range of cardiovascular conditions …”

“…They have shown significant deterioration of RV longitudinal deformation [8][9][10][11] and revealed the association between RV longitudinal strain and functional capacity in hypertensive patients. 12,13 Furthermore, the studies have detected that RV longitudinal strain represents the strongest independent predictor of RV function, 14 as well as the strong relationship between RV longitudinal strain and cardiovascular mortality and morbidity in a wide range of cardiovascular conditions. 15,16 The purpose of this review article is to provide the overview of the current knowledge regarding the role of RV structure, function, and particularly mechanics in hypertensive population.…”