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The epidemiology of hypertensive response to exercise in a large tertiary referral center in Switzerland
1University Hospital Zurich, Department of Cardiology - Zurich - Switzerland
European Journal of Preventive Cardiology
Background: Irrespective of apparent ‘normal’ resting blood pressure (BP) in patients without diagnosed arterial hypertension or with optimally treated arterial hypertension, some individuals show an excessive elevation in BP with exercise, a condition termed exercise hypertension or ‘hypertensive response to exercise’ (HRE). HRE is associated with an increased propensity for target organ damage and also predicts the future development of hypertension, cardiovascular events and mortality, independent of resting BP. So far, systolic HRE was reported more often than diastolic or systolic/diastolic (combined) HRE. Methods: Between January 2009 and May 2012, 2,476 consecutive exercise tests were performed in our institution, a tertiary general cardiology all-comers outpatient clinic. We systematically analyzed all exercise tests with respect to elevated blood pressure at rest (>140/90 mmHg) and at maximal exertion or during the recovery period after exercise (i.e. systolic BP ≥ 210 mmHg in men or ≥ 190 mmHg in women or diastolic BP ≥ 110 mmHg in men or women). Clinical characteristics of all subjects that showed HRE were collected. Results: Of 2,476 exercised patients, 484 (19.5%) patients had elevated BP during exercise (64.0±14.7 years, 70.5% males, coronary artery disease: 48.4%, valvular heart disease: 26.9%, diabetes: 21.9%, BMI 28.1±5.7 kg/m²), of whom 334 (69.0%) had a previously known arterial hypertension. An elevated office blood pressure was found in 172 (35.5% of all patient with elevated BP during exercise) subjects (145 [84.3%] suboptimally treated with known arterial hypertension, 27 [15.7%] previously not diagnosed for arterial hypertension) and therefore did not fulfill the criteria for HRE. The remaining 312 subjects with HRE, that represented 12.6% of all exercise tests subdivided in 189 (60.6%) optimally treated hypertensive patients and 123 (39.4%) subjects without known arterial hypertension. Of all subjects with HRE, 128 had elevated diastolic (5.2% of all exercise tests, 41.0% of all that fulfilled criteria for HRE), 108 (4.3%/34.6%) elevated systolic and 76 (3.1/24.3%) elevated combined (diastolic and systolic) response to exercise. Subjects with diastolic, systolic or combined HRE did not differ with respect to age, gender, body mass index, creatinine clearance, left ventricular ejection fraction; presence of coronary artery disease, valvular heart disease, diabetes, sinus rhythm; or positive family history of arterial hypertension. Conclusions: In our institution, hypertensive response to exercise was found in 12.6% of all exercise tests. Contrary to previous observations, diastolic HRE was found more often than systolic or combined HRE, and subjects with diastolic, systolic or combined HRE did not differ significantly.
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