Tesi etd-01202026-162129 |
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Tipo di tesi
Tesi di specializzazione (5 anni)
Autore
DE BIASE, NICOLO'
URN
etd-01202026-162129
Titolo
Association of a hypertensive response to exercise with cardiac remodelling, vascular function and prognosis in patients with established arterial hypertension
Dipartimento
MEDICINA CLINICA E SPERIMENTALE
Corso di studi
MEDICINA INTERNA
Relatori
relatore Dott. Pugliese, Nicola Riccardo
correlatore Prof. Masi, Stefano
correlatore Prof. Masi, Stefano
Parole chiave
- Arterial hypertension
- Blood pressure
- Echocardiography
- Exercise testing
Data inizio appello
05/02/2026
Consultabilità
Non consultabile
Data di rilascio
05/02/2096
Riassunto
Background. In patients with established arterial hypertension (AH) and preserved left ventricular ejection fraction (LVEF), a hypertensive response to exercise (HRE) may reflect adverse pathophysiology and confer prognostic risk independent of absolute SBP values.
Methods. In this prospective cohort study, we enrolled patients with established AH, with or without HF with preserved ejection fraction (HFpEF), from three centres in Europe. All participants underwent clinical and laboratory assessment, resting transthoracic echocardiography, and combined cardiopulmonary exercise testing-exercise stress echocardiography. We calculated the slope of SBP to peak oxygen consumption (VO₂) from rest to peak exercise and categorized patients into tertiles accordingly; those in the highest tertile were defined as having HRE. Patients were prospectively followed for a composite endpoint of all-cause mortality and HF-related hospitalizations.
Results. The study included 970 patients, of whom 308 (32%) had HFpEF. Compared with those without HRE, patients with HRE exhibited more severe cardiac abnormalities (higher LV mass, lower LV global longitudinal strain), diffuse vascular damage and dysfunction (higher systemic vascular resistance and pulse pressure, higher urinary albumin-to-creatinine ratio), and reduced peripheral oxygen extraction (lower arteriovenous oxygen difference). Over a median follow-up of 24 months, a steeper SBP/VO₂ slope was independently associated with a higher risk of the composite outcome, regardless of absolute SBP and baseline HF status (hazard ratio 1.25, 95% confidence interval 1.07–1.46; p <0.01).
Conclusions. In patients with AH and preserved LVEF, HRE identifies a phenotype characterized by adverse cardiac remodelling, diffuse vascular dysfunction, impaired exercise capacity, and increased risk of adverse outcomes independent of absolute SBP. Whether HRE should inform therapeutic strategies warrants further investigation.
Methods. In this prospective cohort study, we enrolled patients with established AH, with or without HF with preserved ejection fraction (HFpEF), from three centres in Europe. All participants underwent clinical and laboratory assessment, resting transthoracic echocardiography, and combined cardiopulmonary exercise testing-exercise stress echocardiography. We calculated the slope of SBP to peak oxygen consumption (VO₂) from rest to peak exercise and categorized patients into tertiles accordingly; those in the highest tertile were defined as having HRE. Patients were prospectively followed for a composite endpoint of all-cause mortality and HF-related hospitalizations.
Results. The study included 970 patients, of whom 308 (32%) had HFpEF. Compared with those without HRE, patients with HRE exhibited more severe cardiac abnormalities (higher LV mass, lower LV global longitudinal strain), diffuse vascular damage and dysfunction (higher systemic vascular resistance and pulse pressure, higher urinary albumin-to-creatinine ratio), and reduced peripheral oxygen extraction (lower arteriovenous oxygen difference). Over a median follow-up of 24 months, a steeper SBP/VO₂ slope was independently associated with a higher risk of the composite outcome, regardless of absolute SBP and baseline HF status (hazard ratio 1.25, 95% confidence interval 1.07–1.46; p <0.01).
Conclusions. In patients with AH and preserved LVEF, HRE identifies a phenotype characterized by adverse cardiac remodelling, diffuse vascular dysfunction, impaired exercise capacity, and increased risk of adverse outcomes independent of absolute SBP. Whether HRE should inform therapeutic strategies warrants further investigation.
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