Cardiovascular maladaptation to exercise in young hypertensive patients

Background Impairment of the adaptive mechanisms that increase cardiac output during exercise can translate to a reduced functional capacity. We investigated cardiovascular adaptation to exertion in asymptomatic hypertensive patients, aiming to identify the early signs of cardiac and vascular dysfunction. Methods and results We enrolled 54 subjects: 30 patients (45.1 ± 11.9 years, 19 males) and 24 age-matched healthy controls (44.4 ± 9.6 years, 14 males). Speckle-tracking echocardiography (STE) and echo-tracking were performed at rest and during exertion to assess myocardial deformation and arterial stiffness. Results E/E′ increased from rest to peak exercise more in patients than in controls (peak stage: p = 0.024). Global longitudinal strain increased significantly from rest to peak stage in controls (p = 0.011) whereas it remained unchanged in patients (p = 0.777). Left atrial (LA) reservoir was significantly increased throughout the exercise only in controls (p = 0.001) whereas it was almost unchanged in patients (p = 0.293). LA stiffness was significantly higher in patients than in controls both at rest (p = 0.023) and during exercise (p < 0.001). Beta index and pulse wave velocity (PWV) increased during exercise in both groups, showing higher values in patients in each step. Conclusions Our study showed a more pronounced maladaptation during exercise, with respect to rest, of the cardiovascular system with impaired cardiac-vessel coupling in hypertensive patients compared to healthy subjects. Exercise echocardiography implemented by STE and echo-tracking is invaluable in the early detection of these cardiovascular abnormalities.