Статья
Гипертензивная реакция на нагрузку: распространенность и влияние на результаты стресс-эхокардиографии
Актуальность. Гипертензивная реакция артериального давления (АД) на нагрузку (ГРН) имеет существенное прогностическое значение, являясь предиктором развития у пациента гипертонической болезни и церебральных сосудистых событий. Литературные данные о влиянии ГРН на результаты стрессэхокардиографии (стресс-ЭхоКГ) противоречивы. Цель исследования — оценить частоту возникновения ГРН при проведении стресс-ЭхоКГ на тредмиле у пациентов с известной ишемической болезнью сердца или подозрением на нее и влияние ГРН на результаты исследования. Материалы и методы. Были проанализированы результаты 3434 стресс-ЭхоКГ тестов, выполненных в амбулаторном порядке в течение периода 1 месяца (21.01–21.02) каждого года за период с 2007 до 2020 годы. Были изучены частота возникновения ГРН в ходе стресс-ЭхоКГ исследования и взаимосвязь гипертензивной реакции с положительным результатом исследования. Результаты. Распространенность ГРН у пациентов, которым была выполнена стресс-ЭхоКГ в разные годы, составила от 8,6% до 41,5% (в среднем за 14 лет — 23,2%), при этом в период с 2015 по 2020 годы доля тестов с ГРН снизилась. Среди пациентов с ГРН положительный тест встречался чаще, чем среди пациентов с адекватной реакцией АД: 40,6 % против 31,0 % (r = 12,2, р = 0,0005). Выводы. Наличие взаимосвязи между реакцией АД на нагрузку и результатами стресс-ЭхоКГ говорит о влиянии ГРН на результаты исследования и необходимости тщательного подбора антигипертензивной терапии перед исследованием.
1. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. J Am Med A. 2013;310(9):959–968. doi:10.1001/jama.2013.184182.
2. Ерина А. М., Ротарь О. П., Солнцев В. Н., Шальнова С.А., Деев А. Д., Баранова Е.И. и др. Эпидемиология артериальной гипертензии в Российской Федерации — важность выбора критериев диагностики. Кардиология. 2019;59(6):5–11.. doi:10.18087/cardio.2019.6.2595
3. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3):3786. doi:10.15829/1560-4071-2020-3-3786.
4. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33). doi:10.1093/eurheartj/ehy339
5. Holmqvist L, Mortensen L, Kanckos C, Ljungman C, Mehlig K, Manhem K. Exercise blood pressure and the risk of future hypertension. J Hum Hypertens. 2012;26(12):691–695. doi:10.1038/jhh.2011.99
6. Lauer MS, Levy D, Anderson KM, Plehn JF. Is there a relationship between exercise systolic blood pressure response and left ventricular mass? The Framingham Heart Study. Ann Intern Med. 1992;116(3):203–210. doi:10.7326/0003-4819-116-3-203
7. Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S. Exercise blood pressure and future cardiovascular death in asymptomatic individuals. Circulations. 2010;121(19):2109–2116. doi:10.1161/CIRCULATIONAHA.109.895292
8. Balogun MO, Sulyman BO, Akinwusi PO. A comparison of the cardiovascular responses to treadmill and bicycle ergometer exercise in healthy male Nigerians. Afr J Med Med Sci. 1997;26 (1–2):27–30.
9. Yadav A, Bagi J. A study to evaluate cardiovascular responses by using treadmill and ergometer bicycle exercise in young adults. Indian J Health Sciences Biomedical Res (KLEU). 2018;11:81–85. doi:10.4103/kleuhsj.kleuhsj_89_17
10. Tanaka H, Bassett DR, Michael J. Turner exaggerated blood pressure response to maximal exercise in endurance-trained individuals. Am J Hypertens. 1996;9(11):1099–1103. doi:10.1016/0895-7061(96)00238-5
11. Allison TG, Cordeiro MA, Miller TD, Daida H, Squires RW, Gau GT. Prognostic significance of exercise-induced systemic hypertension in healthy subjects. Am J Cardiol. 1999;83(3):371–375. doi:10.1016/s0002-9149(98)00871-6
12. Abram S, Arruda-Olson AM, Scott CG, Pellikka PA, Nkomo VT, Oh JK et al. Typical blood pressure response during dobutamine stress echocardiography of patients without known cardiovascular disease who have normal stress echocardiograms. Eur Heart J Cardiovasc Imaging. 2015;17(5):557–556. doi:10.1093/ehjci/jev165
13. Tsumura K, Hayashi T, Hamada C, Endo G, Fujii S, Okada K. Blood pressure response after two-step exercise as a powerful predictor of hypertension: the Osaka Health Survey. J Hypertens. 2002;20(8):1507–1512. doi:10.1097/00004872-200208000-00012
14. Manolio TA, Burke GL, Savage PJ, Sidney S, Gardin JM, Oberman A. Exercise blood pressure response and 5-year risk of elevated blood pressure in a cohort of young adults: the CARDIA study. Am J Hypertens. 1994;7(3):234–241. doi:10.1093/ajh/7.3.234
15. Filipovský J, Ducimetière P, Safar ME. Prognostic significance of exercise blood pressure and heart rate in middleaged men. Hypertension. 1992;20(3):333–339. doi:10.1161/01.hyp.20.3.333
16. Miyai N, Arita M, Morioka I, Miyashita K, Nishio I, Takeda S. Exercise blood pressure response in subjects with high-normal blood pressure: exaggerated blood pressure response to exercise and risk of future hypertension in subjects with high-normal blood pressure. J Am Coll Cardiol. 2000;36(5):1626–1631. doi:10.1016/s0735-1097(00)00903-7
17. Wilson MF, Sung BH, Pincomb GA, Lovallo WR. Exaggerated pressure response to exercise in men at risk for systemic hypertension. Am J Cardiol. 1990;66(7):731–736. doi:10.1016/0002-9149(90)91139-w
18. Mizuno R, Fujimoto S, Saito Y, Yamazaki M. Clinical importance of detecting exaggerated blood pressure response to exercise on antihypertensive therapy. Heart. 2016;102(11):849–854. doi:10.1136/heartjnl-2015-308805
19. Stewart KJ, Sung J, Silber HA, Fleg JL, Kelemen MD, Turner KL et al. Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function. Am J Hypertens. 2004;17(4):314–320. doi:10.1016/S0895-7061(03)01003-3
20. Tzemos N, Lim PO, Mackenzie IS, MacDonald TM. Exaggerated exercise blood pressure response and future cardiovascular disease. J Clin Hypertens (Greenwich). 2015;17(11):837–844. doi:10.1111/jch.12629.
21. Jae SY, Fernhall B, Heffernan KS, Kang M, Lee MK, Choi YH et al. Exaggerated blood pressure response to exercise is associated with carotid atherosclerosis in apparently healthy men. J Hypertens. 2006;24(5):881–887. doi:10.1097/01.hjh.0000222758.54111.e2
22. Kurl S, Laukkanen JA, Rauramaa R, Lakka TA, Sivenius J, Salonen JT. Systolic blood pressure response to exercise stress test and risk of stroke. Stroke. 2001;32(9):2036–2041. doi:10.1161/hs0901.095395
23. Prada-Delgado O. Prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients without coronary artery disease. Rev Esp Cardiol. 2015;68(2):107–114. doi:10.1016/j.rec.2014.03.023
24. Fagard RH, Pardaens K, Staessen JA, Thijs L. Prognostic value of invasive hemodynamic measurements at rest and during exercise in hypertensive men. Hypertension. 1996;28(1):31–36. doi:10.1161/01.hyp.28.1.31
25. Thanassoulis G, Lyass A, Benjamin EJ, Larson MG, Vita JA, Levy D et al. Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study. Circulation. 2012;125(23):2836–2843. doi:10.1161/CIRCULATIONAHA.111.063933
26. Shim CY, Ha JW, Park S, Choi EY, Choi D, Rim SJ et al. Exaggerated blood pressure response to exercise is associated with augmented rise of angiotensin II during exercise. J Am Coll Cardiol. 2008;52(4):287–292. doi:10.1016/j.jacc.2008.03.052
27. Tzemos N, Lim PO, MacDonald TM. Is exercise blood pressure a marker of vascular endothelial function? QJM: International J Med. 2002;95(7):423–429. doi:10.1093/qjmed/95.7.423
28. Jae SY, Fernhall B, Lee M, Heffernan KS, Lee MK, Choi YH et al. Exaggerated blood pressure response to exercise is associated with inflammatory markers. J Cardiopulm Rehabil. 2006;26(3):145–149. doi:10.1097/00008483-200605000-00005
29. Fagard R, Staessen J, Thijs L, Amery A. Prognostic significance of exercise versus resting blood pressure in hypertensive men. Hypertension. 1991;17(4):574–578. doi:10.1161/01.hyp.17.4.574
30. Fagard RH, Pardaens K, Staessen JA, Thijs L. Prognostic value of invasive hemodynamic measurements at rest and during exercise in hypertensive men. Hypertension. 1996;28(1):31–36. doi:10.1161/01.hyp.28.1.31
31. Donal E, Bergerot C, Thibault H, Ernande L, Loufoua J, Augeul L et al. Influence of afterload on left ventricular radial and longitudinal systolic functions: a two-dimensional strain imaging study. Eur J Echocardiogr. 2009;10(8):914–921. doi:10.1093/ejechocard/jep095
32. Ha J, Juracan E, Mahoney D, Oh JK, Shub C, Seward JB et al. Hypertensive response to exercise: a potential cause for new wall motion abnormality in the absence of coronary artery disease. J Am Coll Cardiol. 2002;39(2):323–327. doi:10.1016/s0735-1097(01)01743-0
33. Mottram PM, Haluska B, Yuda S, Leano R, Marwick TH. Patients with a hypertensive response to exercise have impaired systolic function without diastolic dysfunction or left ventricular hypertrophy. J Am Coll Cardiol. 2004;43(5):848–853. doi:10.1016/j.jacc.2003.08.057
34. Shin JH, Shiota T, Kim YJ, Kwan J, Qin JX, Eto Y et al. False-positive exercise echocardiograms: impact of sex and blood pressure response. Am Heart J. 2003;146(5):914–919. doi:10.1016/S0002-8703(03)00410-1
35. Jurrens TL, From AM, Kane GC, Mulvagh SL, Pellikka PA, McCully RB. An exaggerated blood pressure response to treadmill exercise does not increase the likelihood that exercise echocardiograms are abnormal in men or women. J Am Soc Echocardiogr. 2012;25(10):1113–1119. doi:10.1016/j.echo.2012.07.001
36. Abram S, Arruda-Olson A, Scott C, Pellikka P, Nkomo V, Oh J et al. Frequency, predictors, and implications of abnormal blood pressure responses during dobutamine stress echocardiography. Circ Cardiovasc Imaging. 2017;10: e005444. doi:10.1161/CIRCIMAGING.116.005444
37. Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: From the American Society of Echocardiography. J Am Soc Echocardiogr. 2020;33(1):1–41.e8. doi:10.1016/j.echo.2019.07.001
38. From AM, Kane G, Bruce C, Pellikka PA, Scott C, McCully RB. Characteristics and outcomes of patients with abnormal stress echocardiograms and angiographically mild coronary artery disease (< 50 % stenoses) or normal coronary arteries. J Am Soc Echocardiogr. 2010;23(2):207–14.126. doi:10.1016/j.echo.2009.11.023