DOPPLER-ECHOCARDIOGRAPHIC INDEXES AND 24-H AMBULATORY BLOOD-PRESSURE DATA IN SEDENTARY MIDDLE-AGED MEN PRESENTING EXAGGERATED BLOOD-PRESSURE RESPONSE DURING DYNAMICAL EXERCISE TEST

Previous studies have pointed out that exaggerated blood pressure (BP) response during physical exercise could be an early marker of essenti al hypertension. Apparently some of the exaggerated BP responders pres ent changes in the heart geometry and function that are usually found in the early course of the hypertensive disease. To evaluate the assoc iation between exaggerated BP response and these changes, we submitted 20 normotensive men presenting elevated BP response during bicycle ex ercise (hyperreactive group, systolic BP greater than or equal to 220 mmHg at maximal workload) to 24-h ambulatory blood pressure monitoring (ABPM) and to two-dimensionally guided M-mode echocardiography and pu lsed Doppler. The results from this group were contrasted with those o f a comparable group, which otherwise, presented normal BP response du ring the same procedure (control group, systolic BP less than or equal to 210 mmHg at maximal workload). The ABPM measurements were normal a nd analogous between the two groups: the mean 24-h systolic blood pres sure (SEP) was respectively 126+/-6 mmHg and 129+/-5 mmHg, diastolic b lood pressure (DBP) 82+/-4 mmHg in both groups, and heart rate (HR), r espectively 76+/-9 and 74+/-7 bpm. The univariate correlation (R) betw een the maximal BP response during bicycle exercise and BP measurement s in the ABPM were in general weak and as a whole, the hyperreactive g roup presented the weakest correlation coefficients. M-mode echocardio graphic data such as the left ventricular mass index (LVMI, 80+/-10 vs . 81+/-11 g/m(2)), posterior wall and interventricular septal thicknes s (PWT, 8.8+/-0.6 vs. 8.6 +/-0.7 mm; IVST, 9.0+/-0.4 vs. 8.8+/-0.6) we re also normal and comparable between the groups. LV systolic function al indexes such as fractional shortening (LVFS, 39+/-2.8 vs. 40+/-3.5 %) and ejection fraction (LVEF, 70+/-3.5 vs. 71+/-3.7 %) were also nor mal and similar. Doppler-derived LV diastolic functional indexes such as the peak velocity of early flow divided by the peak velocity of lat e now (RE/A) and isovolumetric relaxation time (IVRT) were also equiva lent (RE/A, both 1.3+/-0.2; IVRT 79+/-7 vs. 81+/-6 msec). These result s support the concept that an exaggerated BP elevation during physical activity, when not accompanied of higher levels of BP during daily ac tivities are not associated with changes in the heart geometry or in t he ventricular function, and might represent an hemodynamical behavior of limited pathological and clinical importance. These conclusions mu st be taken cautiously since personal characteristics such as life sty le, familiar history of hypertension, gender, race and also the levels of BP chosen to delimit a normal and an exaggerated BP response might be important factors determining the consequences of the hyperreactiv e behavior.