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

Yıl 2024, Cilt: 7 Sayı: 2, 219 - 225, 30.06.2024

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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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