Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia.
Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
J Clin Hypertens (Greenwich). 2019 Oct;21(10):1551-1557. doi: 10.1111/jch.13671. Epub 2019 Aug 26.
We sought to assess functional capacity in recently diagnosed untreated hypertensive patients with different 24-hour blood pressure (BP) patterns (dipping, non-dipping, extreme dipping, and reverse dipping). This cross-sectional study involved 164 untreated hypertensive patients who underwent 24-hour ambulatory BP monitoring and cardiopulmonary exercise testing. Our findings showed that 24-hour and daytime BP values did not differ between four groups. Nighttime BP significantly and gradually increased from extreme dippers to reverse dippers. There was no significant difference in BPs at baseline and at the peak of exercise among four observed groups. Peak oxygen consumption (peak VO2) was significantly lower in reverse dippers than in dippers and extreme dippers. Heart rate recovery was significantly lower among reverse dippers than in dippers and extreme dippers. Ventilation/carbon dioxide slope (VE/VCO2) was significantly higher in reverse dippers and non-dippers in comparison with dippers and extreme dippers. Non-dipping BP pattern (non-dippers and reverse dippers together) was independently and negatively associated lower heart rate recovery in the first minute and peak VO2. Reverse dipping BP pattern was independently associated not only with heart rate recovery in the first minute and peak VO2, but also with VE/VCO2. In conclusion, untreated hypertensive patients with reverse dipping BP patterns showed significantly worse functional capacity than those with dipping and extreme dipping BP patterns. Circadian BP rhythm is related with functional capacity and should be taken into account in the risk assessment of hypertensive patients.
我们旨在评估不同 24 小时血压(BP)模式(杓型、非杓型、超杓型和反杓型)的初诊未治疗高血压患者的功能能力。这项横断面研究纳入了 164 名未经治疗的高血压患者,他们接受了 24 小时动态血压监测和心肺运动测试。我们的研究结果表明,四组患者的 24 小时和日间血压值没有差异。夜间血压从超杓型逐渐升高到反杓型。在观察到的四组中,基础血压和运动峰值之间没有显著差异。与杓型和超杓型相比,反杓型患者的峰值摄氧量(peak VO2)显著降低。与杓型和超杓型相比,反杓型患者的心率恢复显著降低。与杓型和超杓型相比,反杓型和非杓型患者的通气/二氧化碳斜率(VE/VCO2)显著升高。与杓型和超杓型相比,非杓型和反杓型(两者合在一起)血压模式与第一分钟和峰值 VO2 的心率恢复呈独立负相关。反杓型血压模式不仅与第一分钟和峰值 VO2 的心率恢复相关,而且与 VE/VCO2 相关。总之,与杓型和超杓型血压模式的未治疗高血压患者相比,反杓型血压模式的患者功能能力明显较差。昼夜血压节律与功能能力相关,应在高血压患者的风险评估中考虑。