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Twenty-year follow-up of hemodynamics in essential hypertension during rest and exercise
1Section of Cardiology, University of Bergen, Haukeland Hospital, Norway.
Insights
Essential hypertension in men shows a progressive hemodynamic decline over 20 years, with initial high cardiac output shifting to low cardiac output and high resistance, even with treatment.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
Background:
- Essential hypertension is a common cardiovascular condition.
- Understanding its long-term hemodynamic alterations is crucial for effective management.
Purpose of the Study:
- To investigate the longitudinal changes in central hemodynamics in men with essential hypertension over two decades.
- To compare hemodynamic patterns between hypertensive individuals and normotensive controls.
Main Methods:
- Invasive hemodynamic measurements (intra-arterial blood pressure, cardiac output via dye-dilution) at rest and during exercise.
- Longitudinal follow-up studies at 10 and 20 years in hypertensive patients.
- Comparison with age-matched normotensive controls.
Main Results:
- Initially, hypertensive men (17-29 years) exhibited higher resting cardiac index and mean arterial pressure compared to controls.
- During exercise, hypertensive patients showed reduced stroke index and increased total peripheral resistance.
- Over 20 years, a shift occurred from a high cardiac index/normal resistance pattern to a low cardiac index/high resistance pattern.
- Even with normalized blood pressure through treatment, hypertensive patients experienced increased total peripheral resistance and decreased cardiac/stroke index.
Conclusions:
- Essential hypertension in men is associated with a progressively abnormal hemodynamic pattern over two decades.
- This hemodynamic deterioration occurs irrespective of age at study onset and persists even with effective blood pressure control.
Abstract:
Central hemodynamics were studied invasively (blood pressure intra-arterially and cardiac output by dye-dilution method) at rest and during exercise in men with essential hypertension and in age-matched normotensive controls. At the start of the study, resting cardiac index, heart rate, oxygen consumption, and mean arterial pressure were approximately 15% higher in those hypertensive patients aged 17-29 years than in normotensive subjects, whereas total peripheral resistance index was similar in both groups. During exercise, the stroke index was reduced and total peripheral resistance index was increased in the hypertensive group. After 10 and then 20 years, central hemodynamics were restudied in the hypertensive patients. The initially high cardiac index/normal total peripheral resistance index pattern changed to a low cardiac index/high resistance pattern at 10- and 20-year follow-up. In 25 patients initially aged 40-49 years, treatment with diuretics, beta-blockers, or a combination of the two normalized diastolic pressure. In spite of adequate blood pressure control, a marked increase in total peripheral resistance and fall in cardiac index and stroke index were also seen in this age group treated over 20 years. The study has shown a progressively abnormal hemodynamic pattern over two decades in patients of different ages with essential hypertension.