Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy
Objective: Hypertensive response to exercise (HRE) is observed in patients with hypertrophic cardiomyopathy (HCM) with normal resting blood pressure (BP). However, the prevalence or prognostic implications of HRE in HCM remain unclear. Methods: In this study, normotensive HCM subjects were enrolled....
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | International Journal of Cardiology. Cardiovascular Risk and Prevention |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772487522000423 |
| _version_ | 1828010076809461760 |
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| author | Dai-Yin Lu Ioannis Ventoulis Hongyun Liu Bereketeab Haileselassie Iraklis Pozios Hsin-Yueh Liang Lars L. Sorensen Marco Canepa Nicole Bavaro Susan Phillip M. Roselle Abraham Theodore P. Abraham |
| author_facet | Dai-Yin Lu Ioannis Ventoulis Hongyun Liu Bereketeab Haileselassie Iraklis Pozios Hsin-Yueh Liang Lars L. Sorensen Marco Canepa Nicole Bavaro Susan Phillip M. Roselle Abraham Theodore P. Abraham |
| author_sort | Dai-Yin Lu |
| collection | DOAJ |
| description | Objective: Hypertensive response to exercise (HRE) is observed in patients with hypertrophic cardiomyopathy (HCM) with normal resting blood pressure (BP). However, the prevalence or prognostic implications of HRE in HCM remain unclear. Methods: In this study, normotensive HCM subjects were enrolled. HRE was defined as systolic BP > 210 mmHg in men or >190 mmHg in women, or diastolic BP > 90 mmHg, or an increase in diastolic BP > 10 mmHg during treadmill exercise. All participants were followed for subsequent development of hypertension, atrial fibrillation (AF), heart failure (HF), sustained ventricular tachycardia/fibrillation (VT/VF), and all-cause death. Six hundred and eighty HCM patients were screened. Results: 347 patients had baseline hypertension, and 333 patients were baseline normotensive. 132 (40%) of the 333 patients had HRE. HRE was associated with female sex, lower body mass index and milder left ventricular outflow tract obstruction. Exercise duration and metabolic equivalents were similar between patients with or without HRE, but the HRE group had higher peak heart rate (HR), better chronotropic response and more rapid HR recovery. Conversely, non-HRE patients were more likely to exhibit chronotropic incompetence and hypotensive response to exercise. After a mean follow-up of 3.4 years, patients with and without HRE had similar risks of progression to hypertension, AF, HF, sustained VT/VF or death. Conclusion: HRE is common in normotensive HCM patients during exercise. HRE did not carry higher risks of future hypertension or cardiovascular adverse outcomes. Conversely, the absence of HRE was associated with chronotropic incompetence and hypotensive response to exercise. |
| first_indexed | 2024-04-10T08:49:36Z |
| format | Article |
| id | doaj.art-e9788cc7303a4d8f9ba9070b9b192ee2 |
| institution | Directory Open Access Journal |
| issn | 2772-4875 |
| language | English |
| last_indexed | 2024-04-10T08:49:36Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology. Cardiovascular Risk and Prevention |
| spelling | doaj.art-e9788cc7303a4d8f9ba9070b9b192ee22023-02-22T04:32:39ZengElsevierInternational Journal of Cardiology. Cardiovascular Risk and Prevention2772-48752023-03-0116200166Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathyDai-Yin Lu0Ioannis Ventoulis1Hongyun Liu2Bereketeab Haileselassie3Iraklis Pozios4Hsin-Yueh Liang5Lars L. Sorensen6Marco Canepa7Nicole Bavaro8Susan Phillip9M. Roselle Abraham10Theodore P. Abraham11Johns Hopkins HCM Center of Excellence, Baltimore, MD, USA; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, University of California San Francisco, San Francisco, CA, USAJohns Hopkins HCM Center of Excellence, Baltimore, MD, USA; Department of Occupational Therapy, University of Western Macedonia, Ptolemaida, GreeceJohns Hopkins HCM Center of Excellence, Baltimore, MD, USAJohns Hopkins HCM Center of Excellence, Baltimore, MD, USA; Department of Pediatrics and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USAJohns Hopkins HCM Center of Excellence, Baltimore, MD, USADivision of Cardiology, China Medical University Hospital, Taichung, TaiwanJohns Hopkins HCM Center of Excellence, Baltimore, MD, USAJohns Hopkins HCM Center of Excellence, Baltimore, MD, USAJohns Hopkins HCM Center of Excellence, Baltimore, MD, USAJohns Hopkins HCM Center of Excellence, Baltimore, MD, USAJohns Hopkins HCM Center of Excellence, Baltimore, MD, USA; Division of Cardiology, University of California San Francisco, San Francisco, CA, USAJohns Hopkins HCM Center of Excellence, Baltimore, MD, USA; Division of Cardiology, University of California San Francisco, San Francisco, CA, USA; Corresponding author. 505 Parnassus Avenue, Moffit 314, San Francisco, CA 94143, USA.Objective: Hypertensive response to exercise (HRE) is observed in patients with hypertrophic cardiomyopathy (HCM) with normal resting blood pressure (BP). However, the prevalence or prognostic implications of HRE in HCM remain unclear. Methods: In this study, normotensive HCM subjects were enrolled. HRE was defined as systolic BP > 210 mmHg in men or >190 mmHg in women, or diastolic BP > 90 mmHg, or an increase in diastolic BP > 10 mmHg during treadmill exercise. All participants were followed for subsequent development of hypertension, atrial fibrillation (AF), heart failure (HF), sustained ventricular tachycardia/fibrillation (VT/VF), and all-cause death. Six hundred and eighty HCM patients were screened. Results: 347 patients had baseline hypertension, and 333 patients were baseline normotensive. 132 (40%) of the 333 patients had HRE. HRE was associated with female sex, lower body mass index and milder left ventricular outflow tract obstruction. Exercise duration and metabolic equivalents were similar between patients with or without HRE, but the HRE group had higher peak heart rate (HR), better chronotropic response and more rapid HR recovery. Conversely, non-HRE patients were more likely to exhibit chronotropic incompetence and hypotensive response to exercise. After a mean follow-up of 3.4 years, patients with and without HRE had similar risks of progression to hypertension, AF, HF, sustained VT/VF or death. Conclusion: HRE is common in normotensive HCM patients during exercise. HRE did not carry higher risks of future hypertension or cardiovascular adverse outcomes. Conversely, the absence of HRE was associated with chronotropic incompetence and hypotensive response to exercise.http://www.sciencedirect.com/science/article/pii/S2772487522000423Blood pressureChronotropic responseExercise stress testHypertensionHypertrophic cardiomyopathyOutcome |
| spellingShingle | Dai-Yin Lu Ioannis Ventoulis Hongyun Liu Bereketeab Haileselassie Iraklis Pozios Hsin-Yueh Liang Lars L. Sorensen Marco Canepa Nicole Bavaro Susan Phillip M. Roselle Abraham Theodore P. Abraham Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy International Journal of Cardiology. Cardiovascular Risk and Prevention Blood pressure Chronotropic response Exercise stress test Hypertension Hypertrophic cardiomyopathy Outcome |
| title | Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy |
| title_full | Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy |
| title_fullStr | Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy |
| title_full_unstemmed | Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy |
| title_short | Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy |
| title_sort | prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy |
| topic | Blood pressure Chronotropic response Exercise stress test Hypertension Hypertrophic cardiomyopathy Outcome |
| url | http://www.sciencedirect.com/science/article/pii/S2772487522000423 |
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