Mount Sinai Rehabilitation Hospital, Hartford, CT 06112, USA.
Atherosclerosis. 2012 May;222(1):202-7. doi: 10.1016/j.atherosclerosis.2012.01.027. Epub 2012 Jan 26.
An elevated systolic blood pressure (SBP) response to a graded maximal exercise stress test (GEST) may be a predictor of endothelial dysfunction and hypertension. We examined relationships among the GEST peak SBP response and indicators of endothelial function.
Men (n=48, 43.7±1.4 yr) with high BP (145.1±1.5/85.5±1.1 mmHg) completed a GEST. Peak SBP was the highest SBP achieved during the GEST. Blood samples were taken for fasting glucose and insulin, nitric oxide (NO), and DNA. Endothelial nitric oxide synthase (NOS3, rs2070744) -786 T>C genotyping was determined by PCR. NOS3 genotypes were combined using a dominant model [TT (n=24); TC/CC (n=24)]. Brachial artery reactivity (BAR) was determined via ultrasound before, 1 min, and 3 min post occlusion and calculated as % change. Analysis of variance (ANOVA) tested changes in the peak SBP GEST response by NOS3 genotype. Multiple variable regression analyses examined relationships among the GEST peak SBP response and measures of endothelial function.
%BAR change at 1 min (r(2)=0.093, p=0.020), glucose (r(2)=0.062, p=0.014), NOS3 -786 T>C (r(2)=0.040, p=0.024), NO (r(2)=0.037, p=0.064), and age (r(2)=0.009, p=0.014) explained 24.1% of the GEST peak SBP response (p=0.043). The GEST peak SBP change from baseline was 11.1±5.0 mmHg higher among those with the NOS3 C allele (92.4 mmHg+3.8) than the NOS3 TT genotype (81.3 mmHg+3.2) (p=0.03).
Indicators of endothelial function appear to explain a clinically significant portion of the GEST peak SBP response. Further investigation is needed to unravel the mechanisms by which endothelial function influences the GEST peak SBP response.
在递增最大运动压力测试（GEST）中，收缩压（SBP）升高可能是内皮功能障碍和高血压的预测指标。我们研究了 GEST 峰值 SBP 反应与内皮功能指标之间的关系。
患有高血压的男性（n=48，43.7±1.4 岁）完成了 GEST。峰值 SBP 是 GEST 期间达到的最高 SBP。采集空腹血糖和胰岛素、一氧化氮（NO）和 DNA 血样。通过 PCR 确定内皮型一氧化氮合酶（NOS3，rs2070744）-786T>C 基因分型。NOS3 基因型采用显性模型组合[TT（n=24）；TC/CC（n=24）]。通过超声在闭塞前、1 分钟和 3 分钟时测定肱动脉反应性（BAR），并计算为%变化。方差分析（ANOVA）检测 NOS3 基因型对 GEST 峰值 SBP 反应的变化。多元变量回归分析研究 GEST 峰值 SBP 反应与内皮功能指标之间的关系。
1 分钟时 BAR 变化率（r(2)=0.093，p=0.020）、血糖（r(2)=0.062，p=0.014）、NOS3-786T>C（r(2)=0.040，p=0.024）、NO（r(2)=0.037，p=0.064）和年龄（r(2)=0.009，p=0.014）解释了 GEST 峰值 SBP 反应的 24.1%（p=0.043）。与 NOS3 TT 基因型（81.3mmHg+3.2mmHg）相比，携带 NOS3 C 等位基因（92.4mmHg+3.8mmHg）的患者 GEST 峰值 SBP 从基线增加了 11.1±5.0mmHg（p=0.03）。
内皮功能指标似乎解释了 GEST 峰值 SBP 反应的一个临床显著部分。需要进一步研究以揭示内皮功能影响 GEST 峰值 SBP 反应的机制。
