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Prognostic value of invasive hemodynamic measurements at rest and during exercise in hypertensive men
R H Fagard1, K Pardaens, J A Staessen
1Department of Molecular and Cardiovascular Research, Faculty of Medicine, University of Leuven, Belgium.
Insights
Systemic vascular resistance, not exercise blood pressure, predicts cardiovascular events and mortality in hypertensive men. Exercise systemic vascular resistance offers additional prognostic value beyond resting measurements.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Hemodynamics
Background:
- Hypertension is a major risk factor for cardiovascular events and mortality.
- Invasive hemodynamic measurements provide detailed insights into cardiovascular function.
- The prognostic value of exercise-induced hemodynamic changes in hypertension requires further clarification.
Purpose of the Study:
- To determine which hemodynamic components of blood pressure predict cardiovascular events and mortality in hypertensive men.
- To assess if hemodynamic responses during exercise enhance prognostic precision beyond resting measurements.
Main Methods:
- Prospective cohort study of 143 hypertensive men with invasive hemodynamic measurements at rest and during exercise (1972-1982).
- Follow-up for cardiovascular events and total mortality over 2186 patient-years.
- Cox regression analysis to identify predictors of cardiovascular events and mortality.
Main Results:
- Resting systolic pressure and systemic vascular resistance predicted cardiovascular events and mortality.
- Exercise systemic vascular resistance, but not exercise blood pressure, added prognostic precision to resting measurements for cardiovascular events.
- Systolic pressure and systemic vascular resistance at peak exercise independently predicted total mortality.
Conclusions:
- Systemic vascular resistance is a key hemodynamic component associated with cardiovascular risk in hypertensive individuals.
- Exercise-induced hemodynamic measurements offer limited additional prognostic value for blood pressure, but systemic vascular resistance during peak exercise provides significant prognostic information.
- These findings highlight the importance of systemic vascular resistance in assessing cardiovascular risk in hypertensive patients.
Abstract:
In 1994, we ascertained the outcome of 143 hypertensive men in whom invasive hemodynamic measurements were performed at rest and during graded bicycle exercise during the period 1972-1982 to assess (1) which of the hemodynamic components of blood pressure is associated with the incidence of cardiovascular events and total mortality, and (2) whether the hemodynamic response to dynamic exercise adds prognostic precision to the data at rest. During 2186 patient years of follow-up, 38 patients suffered at least one fatal or nonfatal cardiovascular event and 17 patients died. Cox regression analysis showed that systolic pressure and systemic vascular resistance measured at rest, during submaximal exercise (50 W), and at peak effort were significant (P < .01) predictors of the age-adjusted incidence of cardiovascular events and total mortality. However, exercise blood pressure did not significantly predict the incidence of cardiovascular events over and above pressure at rest; by contrast, exercise systemic vascular resistance added prognostic precision to vascular resistance at rest (P < .01). As for total mortality, systolic pressure and systemic vascular resistance at peak exercise carried prognostic information that was independent of the results at rest (P < .05); this was not the case for measurements during submaximal exercise. We conclude that the prognostic importance of blood pressure is related to systemic vascular resistance. The prognostic precision of exercise pressure, on top of pressure at rest, is limited. Exercise systemic vascular resistance, however, provides prognostic information beyond that available from measurements at rest, particularly for the incidence of cardiovascular events.