Exercise performance and diastolic filling in essential hypertension.

Abstract

To investigate the relationship between arterial blood pressure, left ventricular mass, diastolic filling and maximal exercise capacity in patients with newly diagnosed essential hypertension. Asymptomatic untreated patients with office blood pressure > 140/90 mmHg were studied prospectively after exclusion of associated disease. Twenty consecutive white patients (14 male, 6 female; age 43 +/- 12 years) with office blood pressure 164 +/- 23/103 +/- 10 mmHg, mean 24-h ambulatory blood pressure 142 +/- 25/89 +/- 15 mmHg and normal systolic cardiac function underwent an echocardiographic examination to determine left ventricular mass and diastolic filling parameters and performed a bicycle ergometer test to determine maximal voluntary exercise capacity. In single regression analysis exercise time and maximal oxygen uptake were related to sex and age. A multiple regression showed that only age was related to exercise capacity, however. On subgroup analysis of male patients between 30 and 50 years (n = 10), exercise time (659 +/- 134 s) was significantly inversely related to mean 24-h ambulatory diastolic blood pressure (92 +/- 11 mmHg) (r = -0.67; p = 0.03) and positively to diastolic filling expressed as ratio of peak early to peak atrial filling velocity (Emax/Amax ratio; 1.34 +/- 0.40) (r = 0.65; p = 0.04) or as ratio of velocity time integral (VTI) of early filling phase to VTI of atrial filling phase (VTIE/VTIA ratio; 1.94 +/- 0.72) (r = 0.02). Maximal oxygen consumption (22.3 +/- 4.1 ml/kg/min) was significantly inversely correlated with mean 24-h ambulatory diastolic blood pressure (r = -0.67; p = 0.03), mean 24-h ambulatory systolic blood pressure (147 +/- 25 mmHg) (r = -0.82; p < 0.01), left ventricular mass (312 +/- 143 g) (r = -0.86; p < 0.01), left ventricular mass index (135 +/- 41 g/m2) (r = -0.76, p = 0.01) and positively with diastolic filling expressed as Emax/Amax ratio (r = 0.71; p = 0.02) or as VTIE/VTIA ratio (r = 0.70; p = 0.02). This study shows the important interrelation between blood pressure, cardiac mass, diastolic filling and exercise capacity. High blood pressure entrains a larger cardiac mass but slows cardiac filling and decreases exercise capacity.