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Park, Jin, Lee, Seong, Lee, Kim, Park, Oh, Ahn, Park, Kim, Park, Lee, Choi, Seong, and Jeong: Association of Blood Pressure and Heart Rate Response to Graded Exercise Test with Left Atrial Volume Index and Pulse Wave Velocity
Original Article

J Korean Soc Hypertens 2013;19(2):45-54.

Published online: 10 June 2013

DOI: https://doi.org/10.5646/jksh.2013.19.2.45

Association of Blood Pressure and Heart Rate Response to Graded Exercise Test with Left Atrial Volume Index and Pulse Wave Velocity

Jae Ho Park, MD*, Seon-Ah Jin, MD*, Young-Dal Lee, MD, Seok-Woo Seong, MD, Hyeon Seok Lee, MD, Mi Joo Kim, MD, Kwang-In Park, MD, Jin Kyung Oh, MD, Kye-Taek Ahn, MD, Soo-Jin Park, MD, Jun-Hyung Kim, MD, Jae-Hyeong Park, MD, Jae-Hwan Lee, MD, Si-Wan Choi, MD, In-Whan Seong, MD, Jin-Ok Jeong, MD

Department of Internal Medicine, Regional Cardiovascular Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea

Tel: 042) 280-8227, Fax: 042) 280-8238 E-mail: jojeong@cnu.ac.kr

* These authors are contributed equally to this work.

Received 26 March 201327 June 2013       Accepted 23 September 2013

Copyright © 2013 The Korean Society of Hypertension

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background:

Exaggerated blood pressure (BP) response to exercise can be an independent risk factor for cardiovascular mortality and morbidity. The purpose of this study was to define the factor that effect on early systolic BP response to exercise.

Methods:

We examined echocardiographic data, BP, heart rate from graded exercise test and brachial ankle pulse wave velocity (PWV) of 205 patients (137 men and 68 women; mean age 58 ± 11 years; range, 19 to 83 years). Graded exercise test was conducted in BRUCE protocol. We define delta systolic blood pressure (SBP) as systolic BRUCE stage “n” BP minus baseline BP.

Results:

Resting BP (127 ± 16 mm Hg) was elevated to 171 ± 26 mm Hg after peak graded exercise test. Resting heart rate (80 ± 15 bpm) was increased to 146 ± 27 bpm after peak graded exercise test. Stepwise regression test between baseline SBP, delta SBP, maximal SBP and left atrial volume index (LAVI) was done. Supine SBP, delta SBP, maximal SBP was not associated with LAVI (p > 0.5). But increased LAVI was significantly associated with delta SBP1 in woman (R2 = 0.192, p = 0.002). PWV was significantly associated with base line (R2 = 0.311, p < 0.01) and maximal SBP (R2 = 0.051, p < 0.01). However, PWV was not associated with delta SBP.

Conclusions:

LAVI and PWV were not associated with early SBP response to exercise. But in women, elevation of early SBP during exercise is associated with LAVI.

Keywords: Exercise test, Pulse wave analysis, Blood pressure, Heart rate

References

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Fig. 1.
Association of left atrial volume index (LAVI) by gender on early systolic blood pressure (SBP) response to exercise. Stepwise regression test between baseline SBP, delta SBP, maximal SBP and LAVI was done. Supine SBP, delta SBP, maximal SBP was not significantly associated with LAVI (p > 0.5). Increased LAVI was significantly associated with delta SBP1 only in woman (R2 = 0.192, p = 0.002). Delta SBP, SBP difference between Bruce protocol stage and baseline ; All, both male and female ; M, male ; F, female.
jksh-19-45f1.tif
Fig. 2.
Association of left pulse wave velocity (PWV) on early systolic blood pressure (SBP) response. PWV was significantly associated with baseline SBP (R2 = 0.311, p < 0.01) and maximal SBP (R2 = 0.051, p < 0.01). But PWV was not associated with delta SBP. All, both male and female ; M, male; F, female ; Lt, left.
jksh-19-45f2.tif
Fig. 3.
Average maximal heart rate was decreased in order of atypical chest pain, stable angina and unstable angina. Maximal heart rate was significantly different according to ischemic heart disease (atypical chest pain vs. stable angina and unstable angina, p = 0.006, < 0.001). However maximal SBP and maximal DBP were not significantly different according to ischemic heart disease. NS, non-specific; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure.
jksh-19-45f3.tif
Table 1.
Baseline characteristics
Characteristic Overall Male Female p-value
Gender 205 (100) 137 (66.8) 68 (33.2)
Age (yr) 58 ± 11 57 ± 12 59 ± 8 0.101
Height (cm) 163.8 ± 8.6 168 ± 6 154 ± 5 <0.001
Weight (kg) 65.9 ± 9.7 69 ± 9 59 ± 7 <0.001
Body mass index 24.5 ± 2.8 24.4 ± 2.8 24.6 ± 2.7 0.56
Cardiovascular risk factors
Hypertension 75/205 (36.5) 50/137 (24.3) 25/68 (12.1) 0.970
Diabetes 35/205 (17.0) 18/137 (8.7) 17/68 (8.2) 0.052
Cerebral infarction 12/205 (5.8) 8/137 (3.9) 4/68 (1.9) 0.990
Smoking 54/205 (26.3) 34/137 (16.5) 20/68 (9.8) 0.484
Serum chemistry
Total cholesterol (mg/dL) 181.9 ± 40 181 ± 38 183 ± 45 0.797
Triglyceride (mg/dL) 144.3 ± 82 142 ± 85 145 ± 76 0.682
LDL cholesterol (mg/dL) 106 ± 34 105 ± 33 107 ± 36 0.701
Creatinin (mg/dL) 0.88 ± 0.26 0.89 ± 0.28 0.88 ± 0.21 0.950
Left atrial volume index 29 ± 12 30.3 ± 14.6 27.8 ± 7.0 0.176
Rt. PWV 1,568 ± 401 1,565 ± 438 1,575 ± 317 0.868
Lt. PWV 1,585 ± 391 1,595 ± 425 1,566 ± 312 0.615
Rt. ABI 1.11 ± 0.12 1.10 ± 0.14 1.11 ± 0.07 0.537
Lt. ABI 1.11 ± 0.11 1.11 ± 0.12 1.10 ± 0.07 0.767
Exercise capacity (METs) 10.0 ± 2.6 10.2 ± 2.8 9.5 ± 2.0 0.02
Bruce protocol
Stage 1 205 (100) 137 (100) 68 (100) 0.390
Stage 2 183 (89.2) 119 (86.8) 64 (94.1) 0.223
Stage 3 133 (64.8) 89 (64.9) 41 (60.2) 0.365
Stage 4 34 (16.5) 21 (15.3) 13 (19.1) 0.686
Stage 5 8 (3.9) 5 (3.6) 3 (4.4) 0.670

Values are presented as number (%) or mean ± standard deviation. LDL, low density lipoprotein; Rt, right; PWV, pulse wave velocity; Lt, left; ABI, ankle brachial index; METs, metabolic equivalents.

Table 2.
BP and HR response to graded exercise test
Variable Total (n = 205) Male (n = 137) Female (n = 68) p-value
Resting SBP (mm Hg) 127 ± 16 127 ± 15 127 ± 17 0.980
Resting DBP (mm Hg) 74.1 ± 10 74.4 ± 10 73 ± 10 0.522
Resting HR (bpm) 80 ± 15 74 ± 10 79 ± 14 0.818
Peak exercise SBP(mmHg) 171 ± 26 172 ± 27 169 ± 24 0.394
Peak exercise DBP (mm Hg) 81 ± 16 80 ± 15 83 ± 18 0.164
Peak exercise HR (bpm) 146 ± 27 146 ± 29 144 ± 24 0.566
SBP at stage 1 (mm Hg) Δ 13 ± 18 9 ± 19 19 ± 14 <0.001
SBP at stage 2 (mm Hg) Δ 26 ± 27 22 ± 22 29 ± 23 0.97
SBP at stage 3 (mm Hg) Δ 33 ± 26 36 ± 24 28 ± 31 0.151

SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; ΔSBP at stage “n” delta, difference between baseline SBP and Bruce protocol “n” stage.

Table 3.
Stepwise analysis of association with delta systolic blood pressure
Variable β R p-value
LAVI Male -0.119 0.260 0.206
Female 0.445 0.438 0.002
Right PWV Male 0.102 - 0.379
Female 0.634 - 0.211
Left PWV Male 0.102 - 0.379
Female -0.580 - 0.254

LAVI, left atrial volume index; PWV, pulse wave velocity.

Table 4.
Intergroup analysis of heart rate
Maximal heart rate of group Mean difference (bpm) (1) - (2) p-value
(1) (2)
Atypical chest pain Stable angina 14.2 0.006
Atypical chest pain Unstable angina 20.2 <0.001
Stable angina Unstable angina 6.0 0.553
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