The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension

J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc. Delayed blood pressure (BP) and heart rate (HR) decline at recovery post‐exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non‐CAD patients (374 normotensive) were followed for new‐onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow‐up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New‐onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28–2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08–2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03–4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14–4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components.     

Sport therapy for hypertension: why, how, and how much?

Exercise may prevent or reduce the effects of metabolic and cardiovascular diseases, including arterial hypertension. Both acute and chronic exercise, alone or combined with lifestyle modifications, decrease blood pressure and avoid or reduce the need for pharmacologic therapy in patients with hypertension. The hypotensive effect of exercise is observed in a large percentage of subjects, with differences due to age, sex, race, health conditions, parental history, and genetic factors. Exercise regulates autonomic nervous system activity, increases shear stress, improves nitric oxide production in endothelial cells and its bioavailability for vascular smooth muscle, up-regulates antioxidant enzymes. Endurance training is primarily effective, and resistance training can be combined with it. Low-to-moderate intensity training in sedentary patients with hypertension is necessary, and tailored programs make exercise safe and effective also in special populations. Supervised or home-based exercise programs allow a nonpharmacological reduction of hypertension and reduce risk factors, with possible beneficial effects on cardiovascular morbidity.     

Effects of aliskiren-based therapy on ambulatory blood pressure profile, central hemodynamics, and arterial stiffness in nondiabetic mild to moderate hypertensive patients

J Clin Hypertens (Greenwich). 2012;00:000–000. ©2012 Wiley Periodicals, Inc. Aliskiren is a direct renin inhibitor that exerts its effect at the rate‐limiting step of the renin‐angiotensin system. This study was performed to examine the beneficial effects of aliskiren‐based antihypertensive therapy on the ambulatory blood pressure (BP) profile, central hemodybamics, and arterial stiffness in untreated Japanese patients with mild to moderate hypertension. Twenty‐one Japanese nondiabetic patients with untreated mild to moderate essential hypertension were initially given aliskiren once daily at 150 mg, and the dose was titrated up to 300 mg as needed. After 12 weeks of aliskiren‐based therapy, the clinic, ambulatory, and central BP values as well as brachial‐ankle pulse wave velocity (baPWV) were all significantly decreased compared with baseline (clinic systolic BP, 151±11 mm Hg vs 132±11 mm Hg; clinic diastolic BP, 91±13 mm Hg vs 82±9 mm Hg; 24‐hour systolic BP, 144±12 mm Hg vs 133±11 mm Hg; 24‐hour diastolic BP, 88±8 mm Hg vs 81±9 mm Hg; central BP, 162±16 mm Hg vs 148±14 mm Hg; baPWV, 1625±245 cm/s vs 1495±199 cm/s; P<.05). These results show that aliskiren, as a first‐line regimen, improves the ambulatory BP profile and may have protective vascular effects in Japanese nondiabetic patients with untreated mild to moderate essential hypertension.     

Exercise in patients with hypertension

A progressive increase in arterial stiffness with aging contributes to systolic hypertension that results in left ventricular hypertrophy and concentric remodeling in the elderly. Lowering of blood pressure in older adults reduces cardiovascular risks. Endurance exercise training can lower blood pressure in older adults with mild (grade I) hypertension. However, the blood pressure-lowering effect of exercise training, compared with antihypertensive medications, is generally modest for both systolic and diastolic blood pressure. Exercise training alone is likely to be ineffective in lowering blood pressure sufficiently in older adults with moderate to severe (grade II and higher) hypertension. However, exercise and weight loss may potentiate the effects of antihypertensive medications in these subjects. Low-intensity endurance exercise training appears to be most effective in reducing blood pressure in older hypertensive adults. Metabolic adaptations to exercise training can significantly reduce other risk factors for coronary artery disease and atherosclerosis, in addition to reducing blood pressure. Endurance exercise training improves exercise capacity and quality of life, and can induce a modest but significant regression of left ventricular hypertrophy and remodeling in older adults with hypertension.     

Hypertensive reaction to exercise. Retrospective studies of 1363 consecutive exercise tests]

OBJECTIVE: To study exercise hypertensive reaction and its relation with rest blood pressure, hypertension type and hypertensive cardiac disease. DESIGN: Retrospective study of treadmill exercise testes (ET) performed from January/89 to June/91: (n: 1703). SETTING: Stress tests Laboratory of Cardiology Service of a Military Hospital. METHODS: 1363 consecutive ET of male subjects, performing at least the 3rd stage of the Bruce protocol, were studied. From each ET record were obtained general data, including the reason for test, medication and the rest and exercise blood pressure. Exercise hypertensive reaction was defined as a Bruce protocol 3rd stage systolic blood pressure above 187 mmHg, which corresponds to mean +2SD of 130 normal male subjects previously studied. The Echocardiograms of non-treated hypertensives, obtained less than a month from ET, were reviewed. The diagnosis of borderline or moderate hypertension was base on the clinical records. RESULTS: 1) The 1363 ET included 132 (9.7%) ET to study hypertensive subjects, and 68 of these had hypertensive reaction. 86 ET were performed by non-treated hypertensive subjects, of whom 73 had Echocardiogram. 43 (3.5%) from 1231 ET performed by non-hypertensive subjects also had exercise hypertensive reaction. 2) The left ventricular (LV) mass index of non-treated hypertensive patients had a positive correlation with exercise systolic pressure (r: 0.45; p < 0.001), more important than with rest blood pressure or exercise systolic pressure response; there was a relation with LV wall thickness, but not with internal ventricular dimensions, that was only observed in hypertensive subjects that also had hypertensive reaction to exercise. 3) Exercise systolic blood pressure was usually normal in borderline and elevated in moderate hypertensives (Qui2: 27.249; p < 0.001). 4) Subjects with exercise hypertensive reaction, but not previously diagnosed as hypertensives, were usually true hypertensives. CONCLUSIONS: 1) Hypertensive peaks seem to be an important determinant factor in LV hypertrophy of hypertension, but its influence is felt only above a certain blood pressure threshold; it results on LV concentric type hypertrophy. 2) Exercise systolic blood pressure had a discrimination power of about 80% to separate borderline and moderate hypertensive subjects. 3) All subjects having an exercise hypertensive reaction must be carefully observed, even if their blood pressure at rest is normal, because most of them are true hypertensive patients.     

Effects of exercise and β-blocker on blood pressure and baroreflexes in spontaneously hypertensive rats

BackgroundExercise training or β-blocker decreases high blood pressure (BP) and improves abnormal baroreflex function associated with hypertension. This study was undertaken to examine whether the effects of exercise training are additive to β-blocker in spontaneously hypertensive rats (SHR).MethodsAt 5 weeks of age, SHR were allocated to four groups: sedentary control, exercise training, treatment with moderate dose of bisoprolol, and their combination. Systolic BP was monitored by the tail-cuff method under restrained conditions. Sigmoidal mean arterial pressure (MAP)–heart rate (HR) reflex curves were obtained in rats at 17 weeks of age under quiet conditions before and after atenolol to ensure sympathetic blockade and to determine the vagal component of gain. After studying baroreflex function, intrinsic HR was obtained by additional administration of atropine.ResultsBefore atenolol, both exercise training alone and bisoprolol alone lowered resting MAP and HR, and decreased upper plateau (maximal tachycardia) and lower plateau (maximal bradycardia), resulting in decreased sympathetic component of HR range (upper plateau − intrinsic HR) and increased vagal component of HR range (intrinsic HR − lower plateau). After atenolol, both exercise training alone and bisoprolol alone increased the gain of vagal component. Exercise training had no additive effect on any parameters to bisoprolol except for systolic BP and HR measured by the tail-cuff method.ConclusionsExercise training and bisoprolol have similar effects concerning resting hemodynamics and baroreflex function in SHR. Although additive effects of exercise training to bisoprolol are not evident under quiet, nonstressful conditions, some additive effects may be obtained under stress such as restrain.     

Cerebrovascular consequences of pseudohyperaldosteronism

J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc. The study of mechanistically defined forms of hypertension may provide insight into the relationship between hypertension and stroke. The author retrospectively studied a cohort of 23 individuals with pseudohyperaldosteronism (PHA), a condition associated with pathologic activation of the distal nephron epithelial sodium channel but low renin and aldosterone levels. During a median follow‐up of 11 years (range: 1–30), 4 of 23 (17.4%) patients had a cerebrovascular event recorded. Intracranial hemorrhage was not observed in any patient. Cerebrovascular events tended to occur in older patients, minorities, and patients with a later diagnosis of PHA and additional vascular risk factors. In addition to strict blood pressure control, patients with PHA should have early evaluation and treatment of other vascular risk factors to reduce the risk of stroke.     

The relationship between exercise capacity and masked hypertension in sedentary patients with diabetes mellitus

Aim: Although exaggerated blood pressure responses (EBPR) to exercise have been related to future hypertension and masked hypertension (MHT), the relationship between exercise capacity and MHT remains unclear. A sedentary life style has been related to increased cardiovascular mortality, diabetes mellitus (DM), and hypertension. In this study, we aimed to examine the relationship between exercise capacity and MHT in sedentary patients with DM.

Methods: This study included 85 sedentary and normotensive patients with DM. Each patient’s daily physical activity level was assessed according to the INTERHEART study. All patients underwent an exercise treadmill test, and exercise duration and capacity were recorded. Blood pressure (BP) was recorded during all exercise stages and BP values ≥200/110?mmHg were accepted as EBPR. MHT was diagnosed in patients having an office BP <140/90?mmHg and a daytime ambulatory BP >135/85?mmHg. Patients were divided into two groups according to their ambulatory BP monitoring (MHT and normotensive group).

Results: The prevalence of MHT was 28.2%. Exercise duration and capacity were lower in the MHT group than in the normotensive group (p?p?=?0.03). According to a multivariate regression, exercise capacity (OR: 0.61, CI95%: 0.39–0.95, p?=?0.03), EBPR (OR: 9.45, CI95%: 1.72–16.90, p?=?0.01), and the duration of DM (OR: 0.84, CI95%: 0.71–0.96, p?=?0.03) were predictors of MHT.

Conclusion: Exercise capacity, EBPR, and the duration of DM were predictors of MHT in sedentary subjects with DM.     

人体质量指数与运动血压的相关性研究

目的：观察人体质量指数（BMI）不同的患者行平板运动试验时运动血压的变化。方法：BMI正常患者224例（正常对照组）,肥胖患者109例（肥胖组）,行平板运动实验检查,比较两组之间运动血压的差别,并分析BMI和运动血压之间的相关性。结果：肥胖组患者静息血压（收缩压、舒张压）,运动峰值血压（收缩压、舒张压）,恢复期血压（收缩压、舒张压）和恢复期脉压均明显高于正常对照组（P〈0.05）。肥胖组患者运动高血压的发生率明显高于正常对照组（9.2%比3.6%,P〈0.05）,且BMI与运动血压呈明显正相关（r=0.123～0.205,P〈0.05）。结论：肥胖患者运动中血压变化异常,提示肥胖患者有血管舒缩功能障碍和心脏自主神经功能紊乱。     

Sauna-induced myocardial ischemia in patients with coronary artery disease.

PURPOSE: Sauna bathing is a popular recreational activity that is generally considered to be safe. However, there have been case reports of adverse cardiac events. We sought to determine whether sauna use caused myocardial ischemia in patients with coronary artery disease. METHODS: Sixteen patients with proven coronary artery disease were submitted to three conditions (rest, exercise, and sauna bathing) with continuous electrocardiographic (ECG) monitoring and regular blood pressure measurements. During each condition, patients were injected with Tc-99 sestamibi followed by nuclear scintigraphic imaging. Perfusion defect scores were calculated in 15 patients. RESULTS: Sauna bathing was well tolerated. There was a mean (+/- SD) increase in heart rate of 32% +/- 20% in the sauna (resting mean heart rate = 60 +/- 9 beats per minute vs sauna mean heart rate = 79 +/- 11 beats per minute, P <0.001) and a 13% +/- 6% drop in systolic blood pressure (resting mean systolic blood pressure = 142 +/- 14 mm Hg vs sauna mean systolic blood pressure = 123 +/- 15 mm Hg, P <0.001). There were no arrhythmias or ECG changes in the sauna. Compared with rest, there was significant ischemia during sauna bathing (average perfusion defect score at rest = -0.44 vs average sauna score = -0.93, P <0.001). The perfusion defect score in the sauna was worse than the resting score in 14 of the 15 patients. Sauna-associated perfusion defect scores were highly correlated with exercise-induced scores (R2 = 0.65, P <0.001). CONCLUSION: In patients with stable coronary artery disease, sauna use is clinically well tolerated but is associated with scintigraphically demonstrated myocardial ischemia.     

Aerobic exercise reduces blood pressure in resistant hypertension

Regular physical exercise is broadly recommended by current European and American hypertension guidelines. It remains elusive, however, whether exercise leads to a reduction of blood pressure in resistant hypertension as well. The present randomized controlled trial examines the cardiovascular effects of aerobic exercise on resistant hypertension. Resistant hypertension was defined as a blood pressure ≥140/90 mm Hg in spite of 3 antihypertensive agents or a blood pressure controlled by ≥4 antihypertensive agents. Fifty subjects with resistant hypertension were randomly assigned to participate or not to participate in an 8- to 12-week treadmill exercise program (target lactate, 2.0±0.5 mmol/L). Blood pressure was assessed by 24-hour monitoring. Arterial compliance and cardiac index were measured by pulse wave analysis. The training program was well tolerated by all of the patients. Exercise significantly decreased systolic and diastolic daytime ambulatory blood pressure by 6±12 and 3±7 mm Hg, respectively (P=0.03 each). Regular exercise reduced blood pressure on exertion and increased physical performance as assessed by maximal oxygen uptake and lactate curves. Arterial compliance and cardiac index remained unchanged. Physical exercise is able to decrease blood pressure even in subjects with low responsiveness to medical treatment. It should be included in the therapeutic approach to resistant hypertension.     

The Efficacy and Safety of Triple vs Dual Combination of Angiotensin II Receptor Blocker and Calcium Channel Blocker and Diuretic: A Systematic Review and Meta‐Analysis

Many hypertensive patients require ≥2 drugs to achieve blood pressure targets. This study aims to review and analyze the clinical studies conducted with dual or triple combination of angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics. Medical literature between January 1990 and April 2012 was reviewed systematically and data from eligible studies were abstracted. Data were analyzed using random‐effects models. Of the 224 studies screened, 7563 eligible patients from 11 studies were included. Triple combinations of ARBs (olmesartan or valsartan), CCBs (amlodipine), and diuretics (hydrochlorothiazide) at any dose provided more blood pressure reduction in office and 24‐hour ambulatory measurements than any dual combination of these molecules (P<.0001 for both). Significantly more patients achieved blood pressure targets with triple combinations (odds ratio, 2.16; P<.0001). Triple combinations did not increase adverse event risk (odds ratio, 0.96; P=.426). Triple combinations at any dose seem to decrease blood pressure more effectively than dual combination of the same molecules without any remarkable risk elevation for adverse events. Further prospective studies evaluating the efficacy and safety of triple combinations, especially in the form of single pills, are required. J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc.     

Combined protocols for myocardial perfusion imaging in patients with hypertension

OBJECTIVE: Patients diagnosed previously with hypertension submitted to exercise testing for myocardial scintigraphy often respond with excessive elevation of the blood pressure, even when baseline blood pressure is normal, resulting in interruption of the test or false positive results for coronary artery disease. The aim of this study was to evaluate the haemodynamic changes and the safety of the combined examination protocols of dipyridamole plus handgrip exercise and of dipyridamole plus symptom-limited exercise testing on a treadmill in patients with hypertension. METHODS AND RESULTS: We performed scintigraphic myocardial single photon emission computed tomography in 240 patients with hypertension as follows: in 27 patients who were administered dipyridamole alone, in 126 patients who were administered dipyridamole and were also submitted to isometric handgrip exercise and in 87 patients who were administered dipyridamole and were also submitted to treadmill, symptom-limited exercise (modified Bruce protocol). Mean systolic blood pressure, mean diastolic blood pressure and heart rate did not rise excessively in patients submitted to exercise testing (192 +/- 18 mm Hg, 106 +/- 14 mm Hg and 111 +/- 21 bpm for the dipyridamole plus handgrip group and 180 +/- 28 mm Hg, 104 +/- 10 mm Hg and 149 +/- 19 bpm for the dipyridamole plus treadmill group, respectively), with two patients from each exercise group presenting a maximum systolic blood pressure higher than 220 mm Hg and no subsequent major cardiac complications (such as death, myocardial infarction, unstable angina or life-threatening arrhythmia). Moreover, patients in these exercise groups experienced fewer non-cardiac side effects than with dipyridamole alone, while attaining a good level of exercise stress. CONCLUSIONS: Both combined dipyridamole and exercise protocols for scintigraphic myocardial single photon emission computed tomography in patients with hypertension are safe and increase heart rate without an excessive elevation in blood pressure. Consequently, they can be recommended for clinical use. Dipyridamole combined with treadmill, symptom-limited exercise would be the first choice, with dipyridamole and isometric handgrip exercise reserved for patients with physical handicaps.     

The Beneficial Effect of Regular Endurance Exercise Training on Blood Pressure and Quality of Life in Patients with Hypertension

Regular aerobic exercise can reduce blood pressure and is recommended as part of the lifestyle modification to reduce high blood pressure and cardiovascular risk. Hypertension itself, or/and pharmacological treatment for hypertension is associated with adverse effects on some aspects of quality of life. This study was performed to evaluate the effects of regular endurance exercise training on quality of life and blood pressure. Patients with mild to moderate hypertension (systolic blood pressure 140–180 or diastolic blood pressure 90–110 mm Hg) were randomized to a moderate‐intensity aerobic exercise group training for 3 sessions/week over 10 weeks or to a non‐exercising control group. Health‐related quality of life was assessed with the Short Form 36‐item Health Survey (SF‐36) at baseline and after 6 and 10 weeks. In the 102 subjects (47 male, mean age 47 years) who completed the study, reductions in blood pressure in the exercise group at 10 weeks (? 13.1/? 6.3 mm Hg) were significant (P < 0.001) compared to baseline and to the control group (? 1.5/+ 6.0 mm Hg). Unlike the control group, the exercise group showed an increase in exercise capacity from 8.2 ± 1.6 to 10.8 ± 2.2 METS (P < 0.01) and showed higher scores on 7 out of 8 subscales (P < 0.05) of the SF‐36. Improvement in bodily pain and general health sub‐scores correlated with reduction in systolic blood pressure. Regular endurance training improves both blood pressure and quality of life in hypertensive patients and should be encouraged more widely.     

Exercise capacity and exercise hypertension after surgical repair of isolated aortic coarctation

There are contradictory reports whether exercise capacity is reduced in patients on long-term follow-up after coarctation repair. Data from unselected patient groups are missing. In a cross-sectional, long-term follow-up study of a tertiary congenital cardiology referral center, 260 patients (30.2+/-11.4 years old, 84 women), after surgical repair for isolated aortic coarctation (age at surgery 11.5+/-11.2 years), underwent a symptom-limited exercise test. Peak workload was 180+/-52 W, significantly less than the age- and height-related reference values (p<0.0005). A peak workload under 80% of expected was found in 200 patients (77%). Exercise performance of the patients was independent from age at surgery, type of surgery, or the systolic brachial-ankle blood pressure difference. The only exercise-limiting factor found was the chronic administration of diuretics to treat hypertension (p=0.005). Exercise hypertension, defined as a systolic blood pressure >2 SD above the load-dependent reference value, was found in 73 patients (28%). It was independently related to the systolic brachial-ankle blood pressure difference (p<0.0005) and diuretics administration (p=0.037). In conclusion, most patients after coarctation repair have a reduced exercise performance. This reduction is not related to the surgical results. Particularly, as these patients are at risk of early atherosclerosis, exercise should be promoted as primary prevention after restenosis, aortic or cerebral aneurysms, and severe exercise hypertension are ruled out.     

Exercise hypertension--significance from the viewpoint of sports

Exercise hypertension refers to an increase in blood pressure during dynamic exercise in excess of the limits in normotensive persons or those with borderline hypertension at rest as well as a disproportionately excessive increase in pressure in hypertensive persons in whom otherwise the increase in exercise pressure is shifted parallel to that of normotensive persons. There is no consensus for the absolute definition of exercise hypertension but traditionally, in sports medicine, systolic blood pressure values of 200 mmHg and more at a workload of 100 watts are considered abnormal. On the basis of the results of a study we performed in 2972 individuals, norms for exercise arterial blood pressure were constructed and found to be related to workload intensity as well as age. In contrast, there was no relationship between exercise blood pressure and exercise capacity or sex. In this regard, indirectly measured diastolic blood pressure is not reliably indicative of the actual prevailing pressure, particularly at higher workloads; it is, therefore, not considered to be useful in detection of exercise hypertension. In agreement with other studies, we found that up to one-third of all patients with normal blood pressure at rest but exercise hypertension eventually developed hypertension at rest. The incidence tended to increase with increasing age. Accordingly, exercise hypertension may be regarded as a precursor to established hypertension at rest.(ABSTRACT TRUNCATED AT 250 WORDS)     

Randomised controlled trial of qigong in the treatment of mild essential hypertension

Exercise and relaxation decrease blood pressure. Qigong is a traditional Chinese exercise consisting of breathing and gentle movements. We conducted a randomised controlled trial to study the effect of Guolin qigong on blood pressure. In all, 88 patients with mild essential hypertension were recruited from the community and randomised to Goulin qigong or conventional exercise for 16 weeks. The main outcome measurements were blood pressure, health status (SF-36 scores), Beck Anxiety and Depression Inventory scores. In the qigong group, blood pressure decreased significantly from 146.3+/-7.8/93.0+/-4.1 mmHg at baseline to 135.5+/-10.0/87.1+/-7.7 mmHg at week 16. In the exercise group, blood pressure also decreased significantly from 140.9+/-10.9/93.1+/-3.5 mmHg to 129.7+/-11.1/86.0+/-7.0 mmHg. Heart rate, weight, BMI, waist circumference, total cholesterol, renin and 24 h urinary albumin excretion significantly decreased in both groups after 16 weeks. General health, bodily pain, social functioning and depression also improved in both groups. No significant differences between qigong and conventional exercise were found. In conclusion, Guolin qigong and conventional exercise have similar effects on blood pressure in patients with mild hypertension. While no additional benefits were identified, it is nevertheless an alternative to conventional exercise in the nondrug treatment of hypertension.     

Exercise in children before and after coarctectomy: hemodynamic, echocardiographic, and biochemical assessment

After repair of coarctation of the aorta, some patients with normal blood pressure at rest have an exaggerated hypertensive response to activity. Blood pressure response to exercise was studied in 15 children, aged 5 to 15 years, prior to and at periods up to 6 months following coarctectomy. Preoperatively, 11 of 15 children had systolic hypertension at rest and 12 of 15 after exercise. After surgery, only one child had mild systolic hypertension at rest, whereas exercise-induced hypertension persisted in 33% of patients (all older than 10 years). Exercise plasma renin activity was elevated preoperatively but normalized following surgery. No significant difference was seen in resting and exercise plasma catecholamine levels measured before and after surgery. Over the follow-up period of 6 months, echocardiographic evidence of left ventricular hypertrophy regressed in the younger patients but not in the older patients with exercise-induced hypertension. Exercise testing defines a subgroup of patients with exercise-induced hypertension evident soon after surgery. Structural upper segment arterial vessel wall changes in the older patient may explain these observations.     

运动血压及其相关影响因素

运动血压即运动试验中的血压,作为高血压研究的重要参数已经引起研究人员的广泛关注。它不仅可以预测正常人群的高血压,而且可对高血压发展及靶器官损害做出评价。现综述运动血压及其影响因素,为高血压的早期预防提供了新思路。     

Effect of the rs168924 single-nucleotide polymorphism in the SLC6A2 catecholamine transporter gene on blood pressure in Caucasians

J Clin Hypertens (Greenwich). 2012; 14:293–298. ©2012 Wiley Periodicals, Inc. The NG_016969.1 :g.5003A>G promoter polymorphism (rs168924) in the SLC6A2 norepinephrine transporter gene was found to be predictive of the hypertensive status in a Japanese population, but no data are available for Caucasians. Genotyping for rs168924 was performed in 282 young men with normal blood pressure (BP), grade 1 or 2 hypertension. In addition to casual BP, 24‐hour ABPM and echocardiography were performed. Multiple regression analysis revealed a significant association of rs168924 genotype with diagnosis of hypertension (P=.044), casual systolic BP (SBP) levels (P=.028), and daytime ambulatory SBP (P=.02). The finding that rs168924 was also significantly associated with diastolic posterior wall thickness (P=.041), an echocardiographic index of hypertensive cardiac target organ damage, further supports the notion that the rs168924 SNP in SLC6A2 in fact might influence BP. Unlike previous findings in a Japanese population, in our Caucasian study cohort the presence of the minor rs168924 G allele was associated with lower prevalence of hypertension. J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc.