Obez Hipertansif Hastalarda Sadece İstirahat Kan Basıncı ile Takip Yeterli mi?

Year 2024, Volume: 7 Issue: 2, 219 - 225, 30.06.2024

Mahmut Esat Elbistan , Hakan Ozer , İsmail Baloğlu , Yasin Öztürk , Mehmet Akif Düzenli , Halil Zeki Tonbul

Abstract

Amaç: Obez bireylerde gün içi ve egzersize cevap olarak oluşan kan basıncı değişkenliği obez olmayan bireylere göre farklılık göstermektedir. Egzersiz sırasındaki kan basıncı değişiklikleri, istirahat kan basıncından bağımsız olarak kardiyovasküler olaylar açısından artmış risk oluşturur. Bu çalışmada, medikal tedavi ile istirahat kan basıncı normal aralıklarda olan obez ve obez olmayan hipertansif (HT) bireylerde egzersizin kan basıncı değişkenliği üzerine etkisini değerlendirdik.
Yöntem: Bu retrospektif çalışmaya, her biri 24 saatlik ambulatuvar kan basıncı takibi (24s AKBM) ve Bruce protokolünde egzersiz testine tabi tutulan 60 hasta (30 obez ve 30 obez olmayan) dahil edildi. Tüm hastaların 24 saatlik AKBM'deki ortalama istirahat kan basınçları normal aralıktaydı. İki grubun efor testindeki kan basıncı değişiklikleri karşılaştırıldı.
Bulgular: Egzersiz testinin her üç düzeyinde de sistolik ve diyastolik kan basıncı artışları obezlerde obez olmayanlara göre daha yüksekti. Egzersiz testinin aşamalarına göre değişmekle birlikte obezlerde sistolik kan basıncındaki artış obez olmayanlara göre 1,3-2 kat, diyastolik kan basıncındaki artış ise 2-2,5 kattı. Hastaların efor testindeki kan basıncı değişiklikleriyle ilişkili faktörler incelendiğinde, VKI'nin egzersiz testinin her 3 aşamasında da kan basıncı değişiklikleriyle korele olduğu görüldü.
Sonuç: Obez HT hastalarının takibinde tek başına istirahat kan basıncı ile değerlendirmenin yetersiz olduğu görülmektedir. Bu nedenle hastalarda kilo kaybına yönelik tedavi stratejileri, antihipertansiflerle kan basıncı kontrolünün mutlak ve sürekli bir parçası olmalıdır. Ayrıca antihipertansif tedaviler gibi egzersiz programları da bu hastalarda bireyselleştirilmelidir.

Keywords

Hipertansiyon, obezite, egzersiz kan basıncı değişkenliği, 24-saat ambulatuvar kan basıncı monitoziasyonu

Is Only Resting Blood Pressure Monitoring Sufficient in Obese Hypertensive Individuals?

Abstract

Objective: Both intraday blood pressure changes and blood pressure response to exercise differ in obese and non-obese individuals. Blood pressure changes in exercise pose an increased risk for cardiovascular events independent of resting blood pressure. In this study, we evaluated the effect of exercise on blood pressure variability in obese and non-obese hypertensive (HT) individuals whose resting blood pressures were within normal ranges with medical treatment.
Methods: This retrospective study included 30 obese and non-obese (total 60) patients, each undergoing 24-hour ambulatory blood pressure monitoring (24h ABPM) and Bruce protocol exercise testing. All patients' mean resting blood pressures at 24h ABPM were within the normal range. The two groups' blood pressure changes in the exertion test were compared.
Results: Systolic and diastolic blood pressure increases were higher in obese than in non-obese at all three levels of the exercise test. Although it varies according to the stages of the exercise test, the increase in systolic blood pressure in obese was 1.3-2 times that of non-obese, and the increase in diastolic blood pressure was 2-2.5 times. When the factors associated with the blood pressure changes in the patients' exertion test were investigated, the BMI was correlated with the blood pressure changes in all 3 stages of the exercise test.
Conclusion: It seems that evaluation with resting blood pressure alone is insufficient in the follow-up of obese HT patients. Therefore, treatment strategies aimed at weight loss in patients should be an absolute and continuous part of blood pressure control with antihypertensives. In addition, exercise programs such as antihypertensive treatments should be determined individually for these patients.

Keywords

Hypertension, Obesity, Blood pressure change in exercise, 24-h ambulatory blood pressure monitoring

References

• Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrolology. 2020;16(4):223-37. doi:10.1038/s41581-019-0244-2
• Faulkner JL. Obesity-associated cardiovascular risk in women: hypertension and heart failure. Clin Sci (Lond). 2021;135(12):1523-44. doi:10.1042/CS20210384
• Ettehad D, Emdin CA, Kiran A. et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. Lancet. 2016;5;387(10022):957-67. doi:10.1016/S0140-6736(15)01225-8
• Lin X, Li H. Obesity: Epidemiology, Pathophysiology, and Therapeutics. Front Endocrinol (Lausanne). 2021;12:706978. doi:10.3389/fendo.2021.706978
• DeMarco VG, Aroor AR, Sowers JR. The pathophysiology of hypertension in patients with obesity. Nat Rev Endocrinol. 2014;10(6):364. doi:10.1038/nrendo.2014.44
• Volpe M, Gallo G. Obesity and cardiovascular disease: An executive document on pathophysiological and clinical links promoted by the Italian Society of Cardiovascular Prevention (SIPREC). Front Cardiovasc Med. 2023;10:1136340. doi:10.3389/fcvm.2023.1136340
• Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288-298. doi:10.1038/s41574-019-0176-8
• Blumenthal JA, Babyak MA, Sherwood A, et al. The Effects Of The Dash Dıet Alone And In Combınatıon Wıth Exercıse And Calorıc Restrıctıon On Insulın Sensıtıvıty And Lıpıds. Hypertension. 2010;55(5):1199. doi:10.1161/HYPERTENSIONAHA.109.149153
• Le VV, Mitiku T, Sungar G, Myers J, Froelicher V. The Blood Pressure Response to Dynamic Exercise Testing: A Systematic Review. Prog Cardiovasc Dis. 2008;1;51(2):135-60. doi:10.1016/j.pcad.2008.07.001
• Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S. Exercise Blood Pressure and Future Cardiovascular Death in Asymptomatic Individuals. Circulation. 2010;5;121(19):2109. doi:10.1161/CIRCULATIONAHA.109.895292
• Schultz MG, Otahal P, Cleland VJ, Blizzard L, Marwick TH, Sharman JE. Exercise-Induced Hypertension, Cardiovascular Events, and Mortality in Patients Undergoing Exercise Stress Testing: A Systematic Review and Meta-Analysis. Am J Hypertens. 2013;26(3):357-66. doi:10.1093/ajh/hps053
• Stolarz-Skrzypek K, Thijs L, et al. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome. Hypertens Res. 2010 338. 2010;8;33(8):757-66. doi:10.1038/hr.2010.110
• Dipla K, Nassis GP, Vrabas IS. Blood Pressure Control at Rest and during Exercise in Obese Children and Adults. J Obes. 2012;2012:1-10. doi:10.1155/2012/147385
• Hayashi M, Denjoy I, Hayashi M, et al. The role of stress test for predicting genetic mutations and future cardiac events in asymptomatic relatives of catecholaminergic polymorphic ventricular tachycardia probands. Europace. 2012;14(9):1344-51. doi:10.1093/europace/eus031
• N.F.G. Walter R. Thompson LSP. ACSM’S Guidelines For Exercise Testing and Prescription. Lippincott Williams&Wilkins: 2010.
• Mundal R, Kjeldsen SE, Sandvik L, Erikssen G, Thaulow E, Erikssen J.Exercise blood pressure predicts mortality from myocardial infarction.Hypertension.1996;27(3I):324-9. doi:10.1161/01.hyp.27.3.324
• Gupta MP, Polena S, Coplan N, et al. Prognostic Significance of Systolic Blood Pressure Increases in Men During Exercise Stress Testing. Am J Cardiol. 2007;100(11):1609-13. doi:10.1016/j.amjcard.2007.06.070
• Tadic M, Cuspidi C, Pencic B, et al. The interaction between blood pressure variability, obesity, and left ventricular mechanics: Findings from the hypertensive population. J Hypertens. 2016;1;34(4):772-80. doi:10.1097/HJH.0000000000000830
• Pickering TG, Harshfield GA, Kleinert HD, Blank S, Laragh JH. Blood Pressure During Normal Daily Activities, Sleep, and Exercise: Comparison of Values in Normal and Hypertensive Subjects. JAMA J Am Med Assoc. 1982;19;247(7):992-6.
• Rasmussen PH, Staats BA, Driscoll DJ, Beck KC, Bonekat HW, Wilcox WD. Direct and indirect blood pressure during exercise. Chest. 1985;87(6):743-8. doi.10.1378/chest.87.6.743
• Fagard R, Staessen J, Thijs L, Amery A. Prognostic significance of exercise versus resting blood pressure in hypertensive men. Hypertension. 1991;17(4):574-8. doi:10.1161/01.hyp.17.4.574
• Keating SE, Coombes JS, Stowasser M, Bailey TG. The Role of Exercise in Patients with Obesity and Hypertension. Curr Hypertens Rep. 2020;1;22(10). doi:10.1007/s11906-020-01087-5
• Filipovsky J, Ducimetiere P, Safar ME. Prognostic significance of exercise blood pressure and heart rate in middle-aged men. Hypertens. 1992;20(3):333-9. doi:10.1161/01.hyp.20.3.333
• Thanassoulis G, Lyass A, Benjamin EJ, et al. Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study. Circulation. 2012;12;125(23):2836-43. doi:10.1161/CIRCULATIONAHA.111.063933
• Prasad VK, Drenowatz C, Hand GA, et al. Relation of Body’s Lean Mass, Fat Mass, and Body Mass Index With Submaximal Systolic Blood Pressure in Young Adult Men. Am J Cardiol. 2016;1;117(3):394-8. doi:10.1016/j.amjcard.2015.10.060
• Stenmark KR, Yeager ME, El Kasmi KC, et al. The adventitia: Essential regulator of vascular wall structure and function. Annu Rev Physiol. 2013;10;75:23-47. doi:10.1146/annurev-physiol-030212-183802
• Sehgel NL, Zhu Y, Sun Z, et al. Increased vascular smooth muscle cell stiffness: A novel mechanism for aortic stiffness in hypertension. Am J Physiol - Hear Circ Physiol. 2013;1;305(9). doi:10.1016/j.bpj.2013.11.2024
• Miyatake N, Matsumoto S, Nishikawa H, Numata T. Relationship between body composition changes and the blood pressure response to exercise test in overweight Japanese subjects. Acta Med Okayama. 2007;61(1):1-7. doi:10.18926/AMO/32913
• Nardin C, Rattazzi M, Pauletto P. Blood Pressure Variability and Therapeutic Implications in Hypertension and Cardiovascular Diseases. High Blood Press Cardiovasc Prev. 2019;1;26(5):353-9. doi:10.1007/s40292-019-00339-z
• Parati G, Faini A, Valentini M. Blood pressure variability: Its measurement and significance in hypertension. Curr Hypertens Rep. 2006;8(3):199-204.