Factors and Prognostic Significance of Impaired Exercise Tolerance in Women over 40 with Arterial Hypertension.

Agata Bielecka-Dabrowa,Agata Sakowicz,Kamil Janikowski,Maciej Banach,Stephan Von Haehling,Katarzyna Gryglewska,Marek Maciejewski

doi:10.3390/jpm11080759

Abstract

The aim of this study was to identify factors influencing maximal oxygen uptake (VO2max) and early identification of the profile of hypertensive women in the perimenopausal period at risk of heart failure. This study included 185 female patients. Regression analyses determined predictors of the lowest VO2max (quartile 1: VO2max < 17 mL/kg/min). Females with the lowest oxygen consumption had a significantly higher level of high sensitive cardiac Troponin T (hs-cTnT) (p = 0.001), higher values of the left atrial (LA) volume, late diastolic mitral annulus velocity (A′), E/E′ (p = 0.0003, p = 0.02, p = 0.04; respectively), higher BMI and fat content (kg and %) (p < 0.0001), higher fat free mass (FFM) (kg) (p < 0.0001), total body water content (TBW) (p = 0.0002) as well as extracellular body water content (ECW) (p < 0.0001) and intracellular body water content (ICW) (p = 0.005), ECW/TBW × 100% (p < 0.0001) and metabolic age (p < 0.0001) and lower E′ (p = 0.001) compared to controls. In a multiple logistic regression model independently associated with VO2max were: ECW/TBW × 100% (OR 4.45, 95% CI: 1.77–11.21; p = 0.002), BMI (OR 7.11, 95% CI: 2.01–25.11; p = 0.002) and hs-cTnT level (OR 2.69, 95% CI: 1.23–5.91; p = 0.013). High-sensitivity cardiac troponin may serve as an early biomarker of heart failure in hypertensive women. Hydration status should be considered in overall hypertensive women care. There is an importance of body mass compartments analysis in the early identification of hypertensive females at risk of heart failure. Optimization and personalization of body structure may be a preventive method for this disease. ClinicalTrials.gov Identifier: NCT04802369.

Highlights

Arterial hypertension is the most relevant factor of cardiovascular risk affecting circulatory diseases’ morbidity and mortality
High-sensitivity cardiac troponin may serve as an early biomarker of heart failure in hypertensive women
Optimization and personalization of body structure may be a preventive method for this disease

Summary

Introduction

Arterial hypertension is the most relevant factor of cardiovascular risk affecting circulatory diseases’ morbidity and mortality. Whether higher cardiovascular risk is a function of aging or a consequence of the menopause and its associated loss of endogenous estrogen has been debated in the literature for many years [6]. Hypertension is the most significant risk factor that affects women in the postmenopausal years. The Framingham study showed that hypertension was associated with 39% of HF cases in men and 59% in women. In both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), women report a much lower quality of life as compared to men [7]. Many women over 40 years of age to primary hypertension development report worsening exercise intolerance as the first symptom of HF. We sought to determine clinical predictors of VO2max decrease in middle-aged hypertensive women

Objectives

Methods

Results

Conclusion