Hypertensive response to exercise, hypertension and heart failure with preserved ejection fraction (HFpEF)-acontinuum of disease?

Abstract

Heart failure with preserved ejection fraction (HFpEF) has been shown to be along-term consequence of uncontrolled arterial hypertension (aHT). Other than that, hypertensive response to exercise (HRE) precedes aHT. We aim to evaluate the available evidence for acontinuum of HRE, aHT and HFpEF. Aliterature search on PubMed was conducted to assembly the most recent data on the topic. After collecting the data, aqualitative analysis was instrumented. 10studies including 16,165 subjects were analyzed with respect to the association between HRE and the future risk of developing aHT. With the exception of one study, all reported on apositive association between HRE and the future development of aHT despite methodological issues related to different definitions for HRE. Furthermore, HRE was associated with an increased risk of coronary artery disease. Moreover, we analysed 6studies including overall 1366 subjects investigating the association between HRE and HFpEF. In these studies, increased left atrial volume index (LAVI), elevatedE/e' (as surrogate parameters of increased LV end-diastolic filling pressure and of diastolic dysfunction) and higher LV mass index have been proposed as independent predictor of HRE in patients with no known HFpEF diagnosis. The literature search revealed suggestive data on aconnection of HRE, aHT and HFpEF. HRE seems to be an independent risk factor for aHT and aHT in turn is one of the main risk factors for HFpEF. However, further research is needed to improve our knowledge of apossible continuum of disease.