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Original article
Clinical importance of detecting exaggerated blood pressure response to exercise on antihypertensive therapy
  1. Reiko Mizuno1,
  2. Shinichi Fujimoto2,
  3. Yoshihiko Saito3,
  4. Masaharu Yamazaki1
  1. 1Central Clinical Laboratory, Nara Medical University, Kashihara, Japan
  2. 2Center for Education Development, Nara Medical University, Kashihara, Japan
  3. 3First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
  1. Correspondence to Dr Reiko Mizuno, Central Clinical Laboratory, Nara Medical University, 840 Shijo, Kashihara, Nara 634-8522, Japan; rmizuno{at}naramed-u.ac.jp

Abstract

Objective In patients with hypertension, regression of left ventricular hypertrophy (LVH) is associated with improved prognosis. Impact of exaggerated blood pressure response to exercise (Ex-BP) seen in patients with hypertension undergoing antihypertensive therapy on the regression of LVH has not been evaluated. This prospective study investigated the relationship between Ex-BP on antihypertensive therapy and the regression of LVH.

Methods We prospectively studied 124 never-treated patients with hypertension with LVH. After a pretreatment evaluation, antihypertensive treatment was started and exercise test was performed in all patients. Patients with Ex-BP were divided into the Ex-BP (+) group and those without were divided into the Ex-BP (−) group. Regression of LVH over the follow-up period was compared between the groups.

Results The follow-up duration was approximately 12 months in both the groups. Mean values of blood pressure at rest during the follow-up period were similar between the groups. Reduction of LVH was seen in both the groups. The magnitude of reduction of LVH was significantly smaller in the Ex-BP (+) group compared with the Ex-BP (−) group. Regression of LVH was much frequently seen in the Ex-BP (+) group compared with the Ex-BP (−) group. Multiple regression analysis determined that on-treatment Ex-BP was an independent negative determinant of antihypertensive treatment-induced reduction of LVH.

Conclusions This study suggests that on-treatment Ex-BP is associated with depressed regression of LVH in patients with hypertension with antihypertensive treatment. If Ex-BP is detected despite receiving antihypertensive agents, improvement of Ex-BP may be necessary to achieve an effective reduction of LVH. Active search of Ex-BP is recommended in patients with hypertension with antihypertensive treatment.

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