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Abnormal left ventricular function occurs on exercise in well-treated hypertensive subjects with normal resting echocardiography
  1. Yu Ting Tan1,
  2. Frauke Wenzelburger1,2,
  3. Eveline Lee2,
  4. Grant Heatlie2,
  5. Michael Frenneaux1,
  6. John E Sanderson1,2
  1. 1Department of Cardiovascular Medicine, University of Birmingham and Queen Elizabeth Hospital, Birmingham, UK
  2. 2University Hospital of North Staffordshire and Keele University, Stoke-on-Trent, UK
  1. Correspondence to Professor John Sanderson, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; jesanderson{at}


Objectives This study tests the hypothesis that patients with treated hypertension with well-controlled blood pressure, without ventricular hypertrophy and normal resting echocardiography, may have abnormalities of ventricular function that are apparent only on exercise and contribute to symptoms of exertional dyspnoea.

Methods Patients with hypertension with well-controlled blood pressure on medication and normal baseline echocardiography underwent cardiopulmonary exercise testing to determine their peak oxygen consumption (Vo2max), followed by rest and submaxinal supine exercise echocardiography (standard, tissue Doppler and speckle tracking).

Results 30 patients with treated hypertension with a history of exertional dyspnoea (mean age 71±8 years; 18 women) and 22 age-matched healthy controls (70±6 years; 16 women) had rest and exercise images of sufficient quality for analysis. Both groups had comparable standard echocardiographic findings at rest. On exercise, the patients had reduced systolic longitudinal function (reserve index 0.97±1.34 vs 2.32±1.24, p=0.001), delayed early untwisting (20.4±7.6 vs 30.6±7.8%, p=0.001) and reduced ventricular suction (velocity propagation 10.6±10.9 vs 24.5±12.2 m/s, p<0.001) compared with healthy controls, which correlated with significantly reduced Vo2max.

Conclusion Patients with treated hypertension with normal resting echocardiography can have exercise limitation associated with widespread systolic and diastolic left ventricular dysfunction on exercise. Normal resting echocardiography does not preclude the presence of significant functional abnormalities on exercise that can contribute to symptoms.

  • Echocardiography
  • exercise
  • hypertension
  • rotation
  • strain
  • untwist

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  • Funding This research was funded by grants from the British Heart Foundation (PG/06/106/21472) and the North Staffs Heart Committee.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the local research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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