Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic
Dai-Yin Lu1,2,3, Ioannis Ventoulis1,4, Hongyun Liu1
1Johns Hopkins HCM Center of Excellence, Baltimore, MD, USA.
Insights
Hypertensive response to exercise (HRE) is common in hypertrophic cardiomyopathy (HCM) patients with normal blood pressure. This response did not increase the risk of future cardiovascular issues or death.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Hypertensive response to exercise (HRE) is noted in hypertrophic cardiomyopathy (HCM) patients with normal resting blood pressure.
- The prevalence and prognostic significance of HRE in HCM are not well-established.
Purpose of the Study:
- To determine the prevalence of HRE in normotensive HCM patients.
- To investigate the prognostic implications of HRE in HCM patients.
Main Methods:
- Normotensive HCM patients underwent treadmill exercise testing.
- HRE was defined by specific systolic and diastolic blood pressure criteria during exercise.
- Participants were followed for adverse cardiovascular outcomes including hypertension, atrial fibrillation, heart failure, ventricular arrhythmias, and all-cause mortality.
Main Results:
- Of 333 normotensive HCM patients, 132 (40%) exhibited HRE.
- HRE was linked to female sex, lower BMI, and less severe left ventricular outflow tract obstruction.
- Patients with HRE showed better chronotropic response and faster heart rate recovery.
- Absence of HRE correlated with chronotropic incompetence and hypotensive response to exercise.
- After a mean follow-up of 3.4 years, no significant difference in adverse outcomes was observed between HRE and non-HRE groups.
Conclusions:
- HRE is a frequent finding in normotensive individuals with HCM during exercise.
- HRE does not appear to confer an increased risk for future hypertension or adverse cardiovascular events in this population.
- The lack of HRE may indicate chronotropic incompetence and a hypotensive response to exercise.
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.
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