Abstract 3109: Exaggerated Blood Pressure Response During Treadmill Test is Accompanied by a State of Pronounced Albuminuria, Hypoadiponectinemia and Increased Asymmetric Dimethylarginine Levels in Essential Hypertension

Abstract

Introduction: A hypertensive response to exercise (HRE) is associated with high cardiovascular risk, whereas the data regarding its relation to markers of atherosclerosis progression are currently scarce. Hypothesis: Urinary albumin excretion, expressed as the albumin to creatinine ratio (ACR), asymmetric dimethylarginine (ADMA) levels, and adiponectin may be correlated with HRE in essential hypertensives. Methods: Our population of 109 newly diagnosed untreated non-diabetics with stage I to II essential hypertension [76 men, mean age =52 years, office blood pressure (BP) = 146/94 mmHg] with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n=34) (peak exercise systolic BP ≥ 210mmHg in men and ≥190 mmHg in women) and to those without HRE (n=75). In all subjects ACR values were determined as the mean of two non-consecutive morning spot urine samples and venous blood samples were drawn for estimation of adiponectin and ADMA concentrations. Results: Patients with HRE compared to those without HRE were older (55 ± 9 vs 51 ± 9 years, p<0.05), had greater 24-h systolic BP (141 ± 13 vs 132 ± 12 mmHg, p<0.05), while did not differ regarding metabolic profile and left ventricular mass index (p = NS). Patients with HRE compared to those without HRE exhibited greater levels of ADMA (0.62 ± 0.05 vs 0.54 ± 0.04 μ mol/l, p<0.0001) and ACR (61.4 ± 12 vs 15.2 ± 2.2 mg/g, p<0.0001), whereas had lower adiponectin values (6.1 ± 1.4 vs 9.3 ± 2.1 μg/ml, p<0.0001), independently of confounders. In the total population, peak exercise systolic BP was related to 24-h systolic BP (r=0.239, p<0.05), ACR (r=0.432, p<0.0001), ADMA (r=0.260, p=0.007), and negatively associated with adiponectin (r = −0.216, p<0.05). Multiple regression analysis revealed that 24-h systolic BP (b=0.232, p=0.023), male sex (b=0.240, p=0.029) and ACR (b=0.450, p<0.0001) were independent predictors of peak exercise systolic BP. Conclusions: In essential hypertension, a HRE is associated with hypoadiponectinemia, augmented ADMA and ACR values, reflecting activation of diverse pro-atherosclerotic pathways. These findings suggest that treadmill exercise testing could be an additional tool to identify hypertensive patients with pronounced cardiorenal vascular dysfunction.