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Central haemodynamics in essential hypertension at rest and during exercise: a 20-year follow-up study
1Section of Cardiology, University of Bergen, Norway.
Insights
Young men with essential hypertension show a concerning long-term shift in cardiovascular function. Over 20 years, their cardiac function declines, and systemic vascular resistance increases, indicating progressive haemodynamic abnormalities.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
- Clinical Haemodynamics
Background:
- Essential hypertension in young males is a significant health concern.
- Understanding the long-term haemodynamic profile of essential hypertension is crucial for effective management.
- Previous studies have not fully elucidated the 20-year haemodynamic trajectory in young hypertensive individuals.
Purpose of the Study:
- To investigate the longitudinal changes in central haemodynamics in young males with essential hypertension over two decades.
- To compare the haemodynamic patterns of hypertensive males with age-matched normotensive controls.
- To characterize the progressive haemodynamic abnormalities associated with essential hypertension.
Main Methods:
- Invasive assessment of central haemodynamics at rest and during exercise.
- Study population included 77 males with essential hypertension (aged 17-66 years) and 33 age-matched normotensives.
- Longitudinal follow-up assessments at 10 and 20 years post-initial study.
Main Results:
- Initially, young hypertensives (17-29 years) exhibited higher cardiac index and oxygen consumption (VO2) with similar total peripheral resistance index compared to normotensives.
- During exercise, hypertensive patients showed a decreased stroke index and increased total peripheral resistance index.
- Over 20 years, a reversal of the initial pattern occurred: reduced cardiac index and elevated total peripheral resistance index at rest and during exercise.
Conclusions:
- Essential hypertension in young males is associated with a progressive haemodynamic deterioration over two decades.
- This deterioration is characterized by declining cardiac function and increasing systemic vascular resistance.
- Findings highlight the need for early intervention and long-term monitoring in young individuals with essential hypertension.
Abstract:
Central haemodynamics were studied invasively at rest and during ergometer-bicycle exercise in 77 males with essential hypertension aged 17-66 years and in 33 age-matched normotensives. At the start of the study, resting cardiac index, the heart rate, oxygen consumption (VO2) and mean arterial blood pressure were about 15% higher in those hypertensive patients aged 17-29 years than in the normotensives while the total peripheral resistance index was similar in both groups. During exercise, the stroke index decreased significantly and the total peripheral resistance index increased in the hypertensive group. After 10, and then 20 years, central haemodynamics were restudied in the hypertensive patients. The initially high cardiac index-low total peripheral resistance index pattern was reversed after 10 years. At the 20-year follow-up there was a further fall in the cardiac index and a more marked increase in the total peripheral resistance index at rest as well as during exercise. The study has shown a progressively abnormal haemodynamic pattern over two decades in young subjects with essential hypertension, characterized by a reduced cardiac function and excessive systemic vascular resistance.