Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy

Dai-Yin Lu; Ioannis Ventoulis; Hongyun Liu; Bereketeab Haileselassie; Iraklis Pozios; Hsin-Yueh Liang; Lars L Sorensen; Marco Canepa; Nicole Bavaro; Susan Phillip; M Roselle Abraham; Theodore P Abraham

doi:10.1016/j.ijcrp.2022.200166

Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy

Int J Cardiol Cardiovasc Risk Prev. 2023 Jan 13:16:200166. doi: 10.1016/j.ijcrp.2022.200166. eCollection 2023 Mar.

Authors

Dai-Yin Lu^{1

2

3}, Ioannis Ventoulis^{1

4}, Hongyun Liu¹, Bereketeab Haileselassie^{1

5}, Iraklis Pozios¹, Hsin-Yueh Liang⁶, Lars L Sorensen¹, Marco Canepa¹, Nicole Bavaro¹, Susan Phillip¹, M Roselle Abraham^{1

3}, Theodore P Abraham^{1

3}

Affiliations

¹ Johns Hopkins HCM Center of Excellence, Baltimore, MD, USA.
² Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Division of Cardiology, University of California San Francisco, San Francisco, CA, USA.
⁴ Department of Occupational Therapy, University of Western Macedonia, Ptolemaida, Greece.
⁵ Department of Pediatrics and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁶ Division of Cardiology, China Medical University Hospital, Taichung, Taiwan.

Abstract

Objective: Hypertensive response to exercise (HRE) is observed in patients with hypertrophic cardiomyopathy (HCM) with normal resting blood pressure (BP). However, the prevalence or prognostic implications of HRE in HCM remain unclear.

Methods: In this study, normotensive HCM subjects were enrolled. HRE was defined as systolic BP > 210 mmHg in men or >190 mmHg in women, or diastolic BP > 90 mmHg, or an increase in diastolic BP > 10 mmHg during treadmill exercise. All participants were followed for subsequent development of hypertension, atrial fibrillation (AF), heart failure (HF), sustained ventricular tachycardia/fibrillation (VT/VF), and all-cause death. Six hundred and eighty HCM patients were screened.

Results: 347 patients had baseline hypertension, and 333 patients were baseline normotensive. 132 (40%) of the 333 patients had HRE. HRE was associated with female sex, lower body mass index and milder left ventricular outflow tract obstruction. Exercise duration and metabolic equivalents were similar between patients with or without HRE, but the HRE group had higher peak heart rate (HR), better chronotropic response and more rapid HR recovery. Conversely, non-HRE patients were more likely to exhibit chronotropic incompetence and hypotensive response to exercise. After a mean follow-up of 3.4 years, patients with and without HRE had similar risks of progression to hypertension, AF, HF, sustained VT/VF or death.

Conclusion: HRE is common in normotensive HCM patients during exercise. HRE did not carry higher risks of future hypertension or cardiovascular adverse outcomes. Conversely, the absence of HRE was associated with chronotropic incompetence and hypotensive response to exercise.

Keywords: Blood pressure; Chronotropic response; Exercise stress test; Hypertension; Hypertrophic cardiomyopathy; Outcome.