Exercise blood pressure and endothelial dysfunction in hypertension

Hypertensive patients with persistent endothelial dysfunction have adverse cardiovascular prognosis. However, current methods aimed to assess endothelial dysfunction in those patients who possess clinical applicability. We hypothesised that such individuals could potentially be identified by an exaggerated systolic blood pressure (BP) response to a submaximal exercise.

We studied 22 male patients with essential hypertension who were categorised into two age-matched groups depending on their exercise systolic BP (ExSBP) rise during the 3-min exercise step test; the exaggerated ExSBP group [hyper-responders (> or = 40 mmHg)] and the low ExSBP responder group [hypo-responders (< or = 20 mmHg)]. Eleven healthy volunteers matched for age were used as control. Clinic and daytime ambulatory BP were assessed after 14 days of anti-hypertensive treatment withdrawal, which were not significantly different between groups. Vascular reactivity in response to intra-arterial infusions of acetylcholine, N(G)-monomethyl-l-arginine (l-NMMA) and sodium nitroprusside was assessed using forearm venous occlusion plethysmography.

The hyper-responder group had significantly less forearm vasodilatation to acetylcholine compared with the hypo-responder group [percentage change in the forearm blood flow 125 (17) vs. 260 (28), mean (SEM); p < 0.001]. Similarly, the vasoconstrictive response to l-NMMA was significantly impaired in the hyper-responder group in comparison to the hypo-responder group [-30 (2) vs. -45 (4); p < 0.05]. In contrast, the vascular response to sodium nitroprusside was not different between groups suggesting preserved endothelial-independent vasodilatation.

Despite similar ambulatory and office BP, the exaggerated ExSBP group had significantly worse endothelial function compared with the low ExSBP responder group. This simple and non-invasive test may be useful in routine clinical practice to aid risk stratification in hypertensive patients.