Studies on Relations between Diurnal and Exercise Blood Pressure Changes, Left Ventricular Mass and Myocardial Ischemia During Treadmill Exercise Test in Patients with Primary Hypertension

Abstract

Background Hypertension as an independent predictor of cardiovascular morbidity and mortality leads to end-organ damage e.g. left ventricular hypertrophy. The aim of the study was estimation of relations between diurnal blood pressure variability, exercise increases in blood pressure, left ventricular mass (LVM), and myocardial ischemia during treadmill exercise test (TET) in patients with mild and moderate essential hypertension.
Material and methods Investigations were carried out in 55 persons with mild and moderate essential hypertension. After withdrawal of all medications 24-hour blood pressure monitoring (ABPM), TET and echocardiography were performed.
Results Patients without 10% nocturnal blood pressure decline (non-dippers) had significantly higher blood pressure values during all 24 hours and separately during day and night observations then patients with preserved nocturnal pressure drop (dippers). There were no differences between pressure elevalions as a result of TET in patients with mild and moderate hypertension, as well as in dippers and non-dippers. Significantly higher LVM index was found in non-dipper compare to dippers. No relations were observed between LVM index and blood pressure changes during ABPM nor TET Positive correlation between LVM index and ST segment depression in ECG during TET in rłon-dippers was found out.
Conclusions In patients with mild and moderate essential hypertension both dippers and non-dippers - no relation between LVM and blood pressure measured during ABPM nor TET was found. In non-dippers LVM was greater than in dippers. In non-dippers greater LVM was accompanied by greater ST depression during TET, which indicates greater myocardial ischaemia in these patients related to left ventricular hypertrophy.