Exercise Blood Pressure Response, Albuminuria, and Arterial Stiffness in Hypertension

Tsioufis, Costas; Dimitriadis, Kyriakos; Thomopoulos, Costas; Tsiachris, Dimitrios; Selima, Maria; Stefanadi, Elli; Tousoulis, Dimitrios; Kallikazaros, Ioannis; Stefanadis, Christodoulos

doi:10.1016/j.amjmed.2008.05.035

« Previous Next »The American Journal of Medicine
Volume 121, Issue 10 , Pages 894-902, October 2008

Exercise Blood Pressure Response, Albuminuria, and Arterial Stiffness in Hypertension

Costas Tsioufis, MD, PhD
- First Cardiology Clinic, University of Athens, Greece
- Requests for reprints should be addressed to Costas Tsioufis, MD, Phd, 43 Agias Marinas Str., Melissia, Athens 15127, Greece
Kyriakos Dimitriadis, MD
- First Cardiology Clinic, University of Athens, Greece
Costas Thomopoulos, MD
- First Cardiology Clinic, University of Athens, Greece
Dimitrios Tsiachris, MD
- First Cardiology Clinic, University of Athens, Greece
Maria Selima, MD
- First Cardiology Clinic, University of Athens, Greece
Elli Stefanadi, MD
- First Cardiology Clinic, University of Athens, Greece
Dimitrios Tousoulis, MD, PhD
- First Cardiology Clinic, University of Athens, Greece
Ioannis Kallikazaros, MD, PhD
- Department of Cardiology, Hippokration Hospital, Athens, Greece
Christodoulos Stefanadis, MD, PhD
- First Cardiology Clinic, University of Athens, Greece

Abstract

Background

A hypertensive response to exercise is associated with high cardiovascular risk, whereas the data about its relation to surrogates of subclinical atherosclerosis are scarce. We investigated the relationships of a hypertensive response to exercise with urinary albumin excretion and arterial stiffness in hypertensives.

Methods

There were 171 untreated males (mean age 52 years, all Caucasian) with stage I-II essential hypertension and a negative treadmill exercise test divided into those with a hypertensive response to exercise (n=48) (peak exercise systolic blood pressure ≥210 mm Hg) and to those with normal blood pressure response (n=123). Albumin-to-creatinine ratio values were determined as the mean of 3 nonconsecutive morning spot urine samples, and arterial stiffness was evaluated on the basis of carotid-to-femoral pulse wave velocity.

Results

Patients with a hypertensive response to exercise compared with those with normal blood pressure response exhibited greater log albumin-to-creatinine ratio (1.52±0.59 vs 0.97±0.33 mg/g) and higher pulse wave velocity (8.7±1.6 vs 7.7±1.2 m/s), independent of potentially confounding demographic and clinical factors. Resting systolic blood pressure (odds ratio [OR] 1.11, 95% confidence interval [CI], 1.06-1.16), body mass index (OR 1.12, 95% CI, 1.02-1.23), resting heart rate (OR 0.96, 95% CI, 0.93-0.99), and albumin-to-creatinine ratio (OR 7.45, 95% CI, 2.54-21.83) were independently associated with a hypertensive response to exercise.

Conclusion

A hypertensive response to exercise is related to augmented albumin-to-creatinine ratio and arterial stiffness, reflecting accelerated subclinical atherosclerosis. The association of albumin excretion with exercise blood pressure response suggests that albuminuria constitutes an important factor in the interpretation of the hypertensive response to exercise-associated risk.

Keywords: Albuminuria, Arterial stiffness, Exercise testing, Hypertension