Abstract
Background: Prehypertension is a highly prevalent condition, but its pathophysiology is still poorly understood. Heart rate recovery (HRR), noninvasive parameter acquired during treadmill test, is an index of autonomic dysfunction. We aimed to evaluate the association of prehypertension with autonomic dysfunction, and further, to identify the determinants of autonomic dysfunction. Methods: We retrospectively identified 557 asymptomatic participants who did not have hypertension and underwent comprehensive health check-ups including cardiopulmonary exercise test. They were categorized into two groups: optimal blood pressure (BP) (systolic BP<120mmHg and diastolic BP<80mmHg, n=277) and prehypertension (120≤systolic BP<140mmHg and/or 80 ≤diastolic BP<89mmHg, n=280). HRR at 1 minute (HRR 1 ) was also calculated as follows: peak heart rate (HR) minus HR after 1-minute recovery. Results: Prehypertension group exhibited more obese feature (waist circumference, 83.3±7.3 vs. 87.4±8.1cm; p<0.001) and metabolic disturbance (HOMA-IR, 0.93±0.85 vs. 1.26±1.06; uric acid 5.5±1.4 vs. 5.9±1.4; HDL-cholesterol 52.4±13.6 vs. 48.5±12.2 mg/dL; all p<0.005). They also had high pulse wave velocity (PWV, 1315.7±143.0 vs. 1453.1±187.1cm/sec, p<0.001). Although the resting HR and peak exercise HR did not differ between the groups, prehypertension group exhibited a significantly lower HRR 1 level, suggesting an impaired parasympathetic reactivation in the prehypertension (39.3±14.7 vs. 36.2±14.9 beats/min, p=0.016). In a multivariate linear regression analysis, resting HR ( ß =-0.360, p<0.001), waist circumference ( ß =-0.195, p=0.018), PWV ( ß =-0.008, p=0.017), and HDL-cholesterol ( ß =0.105, p=0.036) were independent determinants of the HRR 1 . Conclusions: Prehypertension is associated with metabolic disturbance and autonomic dysfunction. HRR is mainly determined by waist circumference, arterial stiffness, and dyslipidemia even after adjustment for the resting HR. Our observation suggests the possible role of metabolic-autonomic abnormality in the pathogenesis of prehypertension.
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