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PubMed1992

ECG gated radionuclide plethysmography--a method for the assessment of pulmonary systolic blood volume increase.

During cardiac systole the stroke volume of blood which is ejected from the right ventricle increases the pulmonary blood volume. This systolic pulmonary blood volume increase is measured by using ECG gated chest scintigrams obtained with 99Tcm-labelled red blood cells. The total radiation counts in a region of interest that includes either the right or the left lung increases during systole. On the average, the increase of the total pulmonary systolic radiation was found to be 62% of the systolic radiation decrease in the left ventricle region of interest. The discrepancy between the value of the systolic pulmonary blood volume increase and that of stroke volume is attributed to blood flow from the lungs into the left atrium during the cardiac systole period.

Adult↗
PubMed2002

Blood pressure and decline in kidney function: findings from the Systolic Hypertension in the Elderly Program (SHEP).

The association between BP and decline in kidney function in older persons and the BP component most responsible for kidney disease are unknown. This study investigated the relationship between baseline BP and an incident decline in kidney function among 2181 men and women enrolled in the placebo arm of the Systolic Hypertension in the Elderly Program (SHEP). A decline in kidney function was defined as an increase in serum creatinine equal to or greater than 0.4 mg/dl over 5 yr of follow-up. The incidence and relative risk of a decline in kidney function increased at higher levels of BP for all BP components, independent of age, gender, ethnicity, smoking, diabetes, and history of cardiovascular disease. Systolic BP imparted the highest risk of decline in kidney function. The adjusted relative risk (95% confidence interval) associated with the highest compared with the lowest quartile of BP was 2.44 (1.67 to 3.56) for systolic; 1.29 (0.87 to 1.91) for diastolic; 1.80 (1.21 to 2.66) for pulse; and 2.03 (1.39 to 2.94) for mean arterial pressure. The risk associated with systolic BP remained strong in models containing other BP components, while diastolic, pulse, and mean arterial pressure had no significant association with a decline in kidney function in models containing systolic BP. Therefore, systolic BP is a strong, independent predictor of a decline in kidney function among older persons with isolated systolic hypertension.

Aged↗
PubMed1999

Discrete systolic potentials during ventricular tachycardia in patients with prior myocardial infarction.

INTRODUCTION: Isolated diastolic potentials have been found to be helpful in identifying critical sites for ablation of ventricular tachycardia (VT) in patients with coronary artery disease. However, discrete potentials that occur during systole have not been previously described. The purpose of this study was to determine the significance of discrete systolic potentials during VT in patients with coronary artery disease. METHODS AND RESULTS: Twenty-seven patients with a mean age of 66 +/- 12 years ( +/- standard deviation) who had coronary artery disease underwent radiofrequency catheter ablation of 42 VTs that had a mean cycle length of 486 +/- 78 msec. The only criterion used to select target sites for ablation was concealed entrainment, which was present at 92 sites. Thirty-five of the 42 VTs (83%) were successfully ablated. A discrete systolic potential was recorded during 7 of the 42 VTs (17%). In all cases, the interval between the discrete systolic potential and the next QRS complex was equal to the stimulus-QRS interval during concealed entrainment. At all seven sites where a discrete systolic potential was recorded, delivery of radiofrequency energy resulted in successful ablation of the VT. CONCLUSION: Discrete systolic potentials may be present in patients with coronary artery disease in approximately 17% of VTs in which there is concealed entrainment. If the interval between the discrete systolic potential and the next QRS complex matches the stimulus-QRS interval during concealed entrainment, delivery of radiofrequency energy is likely to result in successful ablation of the VT.

Action Potentials↗
PubMed1999

Differentiating systolic from diastolic heart failure using impedance cardiography.

OBJECTIVE: Differentiating systolic from diastolic congestive heart failure (CHF) is often difficult in the ED. Impedance cardiography (IC) allows for the noninvasive evaluation of systolic function and measurement of diastolic time intervals. This study was designed to assess the ability of IC to accurately measure isovolumic relaxation time (IVRT) and determine relative cardiac contractility, thereby differentiating systolic from diastolic mechanisms in acute CHF. METHODS: In an evaluation of the technique, the average differences in the diastolic time intervals measured in normal subjects by both IC tracings and phonocardiography were compared. Likewise, the average Heather index (HI) of patients with known systolic dysfunction (ejection fraction < 30% by echo-cardiography) was compared with the mean HI measured in the normal subjects. In a retrospective analysis, the clinical performance of the method was examined by extracting the values of IVRT and HI from IC tracings of patients presenting with CHF. The determined IVRT and HI values were then correlated to clinical markers for diastolic and systolic dysfunction. RESULTS: Analysis of 280 IC tracings in eight healthy volunteers revealed an average difference of 0.0075 seconds (95% CI = -0.0067 to 0.0217) when IVRT intervals measured by phonocardiography and IC are compared. The HI in this normal group averaged 14.2 (95% CI = 9.4 to 19.0), contrasting to the much lower value of 2.8 (95% CI = 1.98 to 3.62) seen in eight subjects with documented systolic dysfunction. In 26 patients with decompensated CHF, there was a close correlation (r = 0.81) of the measured IVRT to left ventricular hypertrophy by voltage criteria and while a fall in the HI was correlated with intravascular volume expansion. Though there was considerable overlap (46%) in mechanisms of CHF, 35% of the patients were found to have only systolic dysfunction (HI < 5 and IVRT < 0.125), while 19% had a predominantly diastolic etiology (IVRT > 0.125 and HI > 5) for their failure. CONCLUSION: IC measures of contractility and diastolic time intervals are a potentially effective method for differentiating the dominant mechanisms of CHF in the emergent setting and categorizing CHF patients into different subsets.

Acute Disease↗
PubMed1981

Specificity of systolic anterior motion of anterior mitral leaflet for hypertrophic cardiomyopathy. Prevalence in large population of patients with other cardiac diseases.

The value of systolic anterior motion of the anterior mitral leaflet as a diagnostic marker for hypertrophic cardiomyopathy has been questioned because of its reported occurrence in other heart diseases. To determine the true specificity of systolic anterior motion for hypertrophic cardiomyopathy, 721 echocardiograms from patients with a wide variety of cardiac diseases were reviewed for its presence or absence under basal conditions. Systolic anterior motion of the anterior mitral leaflet was present in only 22 (3.0%) of the 721 patients, giving a specificity of 97 per cent. It was most common in patients with d-transposition of the great vessels (11 of 51, or 21%). With patients having transposition of the great vessels excluded from the analysis, the prevalence of systolic anterior motion of the anterior mitral leaflet was only 1.6 per cent (specificity 98%). Of note, eight of the 11 patients with systolic anterior motion of the anterior mitral leaflet and diseases other than transposition of the great vessels had disproportionate thickening of the ventricular septum, making it exceedingly rare in a patient population with normal septal-free wall thickness ratios (prevalence 0.4%; specificity 99%). Hence, while systolic anterior motion is not pathognomonic of hypertrophic cardiomyopathy, it was an uncommon finding in a large population of patients with a variety of cardiac diseases; when present in such patients systolic anterior motion of the anterior mitral leaflet is usually associated with disproportionate septal thickening.

Adolescent↗
PubMed1995

Cross sectional profiles of systolic flow velocities in left ventricular outflow tract of normal subjects.

BACKGROUND: The idea that blood passes through the left ventricular outflow tract with a flat velocity profile has recently been questioned. OBJECTIVE: To construct flow velocity profiles by magnetic resonance imaging over the whole cross sectional subaortic flow area in normal subjects. SUBJECTS: Nine people without heart disease aged 25 to 56. DESIGN: Cardiac gated cine magnetic resonance images were produced with a 1.0 T magnet perpendicular to the longitudinal axis of the left ventricular outflow tract 0.5 to 1.0 cm below the aortic annulus in mid-systole. Velocity was encoded every 30-40 ms throughout systole in the direction of flow perpendicular to the image plane. MAIN OUTCOME MEASURES: Systolic velocity-time curves reconstructed in nine different regions (area of each circle 0.2 cm2) of the subaortic flow area. The systolic peak velocity and the mean flow rate were taken as indices of regional flow. RESULTS: The spatial inhomogeneity of the peak velocity, calculated as the percentage ratio of the range of the regional measurements to their mean, averaged 18.2% (5.0%), and the inhomogeneity of the mean flow rate was 19.2% (3.5%). There were significant trends (P < 0.05) across the regional measurements towards highest peak velocities and mean systolic flow rate in the anteromedial sector of the subaortic flow area. The peak systolic velocity in the centre of the flow area averaged 98 (8) cm/s while the coincident spatial average was 94 (5) cm (P = 0.013). CONCLUSIONS: The distribution of systolic velocities across the left ventricular outflow tract is skewed towards fastest flow in the anteromedial sector of the flow area. The peak velocities measured in the centre of the flow area slightly overestimate the coincident spatial average velocities.

Adult↗
PubMed1995

Diastolic aortic pressure rise during percutaneous transluminal coronary angioplasty: an index of left ventricular systolic dysfunction.

OBJECTIVES: To investigate the relation between diastolic aortic pressure response and left ventricular systolic dysfunction during percutaneous transluminal coronary angioplasty. BACKGROUND: The abnormal diastolic blood pressure rise during exercise in patients with coronary artery disease probably reflects left ventricular systolic dysfunction rather than the number of stenosed coronary arteries. METHODS: Aortic blood pressures and left ventricular systolic function indices were estimated in 26 patients with single proximal stenosis of the left anterior descending coronary artery both before and during angioplasty. RESULTS: During coronary angioplasty all patients presented an increase in diastolic aortic pressure (P << 0.001), 8-12s before intracoronary electrocardiographic changes. During acute ischaemia there was a decrease in left ventricular ejection fraction (P << 0.001) and stroke volume (P << 0.001) and an increase in end systolic volume (P << 0.001) and left ventricular end diastolic pressure (P << 0.001). No statistically significant changes were observed in systolic blood pressure or heart rate. The aortic diastolic pressure increase was correlated with the decrease in ejection fraction (r = -0.95, P << 0.001) and with the increases in end systolic volume (r = 0.86, P << 0.001) and left ventricular end diastolic pressure (r = 0.85, P << 0.001). CONCLUSIONS: The rise in diastolic aortic pressure during percutaneous transluminal coronary angioplasty occurs earlier than intracoronary electrocardiographic changes and is related to ischaemic left ventricular systolic dysfunction.

Angioplasty, Balloon, Coronary↗
PubMed1981

Preload changes modify systolic pressure-diameter relations in the conscious dog.

The behavior of the end-systolic ventricular diameter was examined during control state, atrial pacing, and acute volume loading (VL) followed by methoxamine infusion in conscious dogs instrumented with a left ventricular micromanometer and ultrasonic crystals measuring internal diameter and wall thickness. Heart rate and systolic pressure were markedly increased by maximal VL but for moderate VL were minimally modified. Moderate VL increased end-diastolic diameter by 5% and end-systolic diameter by 2.9% with a significant increase of systolic stress. There was no common final pathway of shortening in the force-velocity-length diagram for different preloads. During methoxamine infusion, the end-systolic pressure-diameter points described a linear regression but points obtained during atrial pacing before VL were significantly shorter. We conclude that VL increases the total loading of the heart producing a lengthening of the end-systolic diameter when end-diastolic diameter is increased. This reduces the expression of the Starling mechanism and suggests caution when interpreting end-systolic pressure-diameter relations and derived indices for significantly different end-diastolic diameters.

Animals↗
PubMed1994

Left ventricular systolic performance is depressed in chronic pulmonary emphysema in dogs.

The effect of chronic right ventricular (RV) pressure overload on left ventricular (LV) systolic function in chronic obstructive lung disease is unclear. To examine LV systolic performance in pulmonary emphysema, a chronic canine model was developed in which pulmonary artery pressure could be elevated to a level found in human disease. Severe emphysema was produced by the repeated instillations of the enzyme papain into the lung. Sonomicrometry was used to assess LV dimensions along the septal-lateral, apex-base, and anterior-posterior orthogonal axes of the LV. With the animal conscious, measurements of LV systolic function were obtained over a wide range of LV circumferential end-ejection stresses at baseline and after 1 yr of emphysema (post-1-yr study). In the emphysema group (n = 5), the results showed that at the post-1-yr study, measurements of LV ejection fraction, mean velocity of circumferential shortening, and rate of anterior-posterior dimensional shortening were reduced compared with those obtained at the baseline study. In the emphysema group, end-systolic volume was increased for a given end-systolic pressure or stress at the post-1-yr study compared with baseline values, while fractional shortening measured along the three axes was decreased. There were no similar changes in systolic parameters in control groups. We conclude that chronic RV pressure overload may cause an impairment in LV systolic performance in chronic emphysema.

Analysis of Variance↗
PubMed1994

Loss of elastic recoil in postischemic myocardium induces rightward shift of the systolic pressure-volume relationship.

Ischemia-induced systolic dysfunction has been ascribed to changes in cellular excitation-contraction coupling and diastolic dysfunction because of disruption of the extracellular collagen matrix. Therefore, systolic and diastolic pressure-volume relationships and O2 consumption were determined before and after 5 min of global ischemia in isolated blood-perfused porcine hearts. The slope of the systolic pressure-volume relationship was 7.2 +/- 0.6 (SE) mmHg.ml-1.100 g-1 (n = 18) at baseline and did not change during reperfusion, but the systolic volume intercept shifted from 1.0 +/- 0.4 ml/100 g at baseline to 3.7 +/- 1.4, 4.1 +/- 1.1, and 4.2 +/- 0.9 ml/100 g at 15, 30, and 60 min of reperfusion, respectively (all P < 0.05). The diastolic volume intercept was 8.2 +/- 0.7 ml/100 g at baseline and remained unchanged during reperfusion. Therefore, the difference of the systolic-diastolic volume intercepts, an index of elastic recoil forces, was decreased to 57 +/- 8, 49 +/- 7, and 47 +/- 9% of baseline values (P < 0.05). The shift of the systolic pressure-volume relationship was accompanied by a transient decrease of contractile efficiency (slope of O2 consumption-pressure-volume-area relationship) at 15 min of reperfusion (from 43 +/- 6 to 27 +/- 7%). We hypothesize that the rightward shift of the systolic pressure-volume relationship was compatible with a decrease of elastic-restoring forces, probably induced by alterations in the extracellular collagen matrix and/or the cytoskeleton, and thereby our data imply that left ventricular dysfunction of postischemic myocardium does not result solely from disturbances in excitation-contraction coupling.

Animals↗
PubMed1995

Effects of inotropic stimulation on energy metabolism and systolic function of ischemic right ventricle.

This study determined whether dobutamine enhances regional systolic function in the ischemic right ventricle (RV) at the cost of adverse effects on regional energy metabolism. Seventeen alpha-chloralose-anesthetized, open-chest pigs were studied under four conditions: 1) control; 2) dobutamine infusion (mean dose 9 micrograms.kg-1.min-1); 3) RV ischemia (45 +/- 5% reduction in RV free wall blood flow for 100 min); and 4) continued ischemia with dobutamine. Regional RV free wall high-energy phosphate metabolites were measured by 31P nuclear magnetic resonance (NMR) spectroscopy or by high-speed drill biopsies of the RV free wall. Regional RV free wall substrate and O2 consumption were measured using coronary venous blood sampling. Global RV systolic function was assessed by the maximal first derivative of RV pressure (dP/dtmax), and regional RV free wall systolic function was assessed by systolic segment shortening in the ischemic zone. Right coronary artery constriction caused markedly depressed regional RV systolic function, net lactate production, and coronary venous acidosis. Surprisingly, high-energy phosphates were unchanged compared with control. Addition of dobutamine caused a further decline in coronary venous pH and continued lactate production but did not reduce high-energy phosphates. While dobutamine markedly enhanced global RV systolic function (RV dP/dtmax 201 +/- 19% of control), systolic shortening in the ischemic RV free wall remained severely depressed (47 +/- 18% of control) despite dobutamine. The mechanism of high-energy phosphate preservation is likely due to diminished consumption of ATP in the hypocontractile ischemic region.

Animals↗
PubMed2004

Importance of mitral valve second-order chordae for left ventricular geometry, wall thickening mechanics, and global systolic function.

BACKGROUND: Mitral valvular-ventricular continuity is important for left ventricular (LV) systolic function, but the specific contributions of the anterior leaflet second-order "strut" chordae are unknown. METHODS AND RESULTS: Eight sheep had radiopaque markers implanted to silhouette the LV, annulus, and papillary muscles (PMs); 3 transmural bead columns were inserted into the mid-lateral wall between the PMs. The strut chordae were encircled with exteriorized wire snares. Three-dimensional marker images and hemodynamic data were acquired before and after chordal cutting. Preload recruitable stroke work (PRSW) and end-systolic elastance (E(es)) were calculated to assess global LV systolic function (n=7). Transmural strains were measured from bead displacements (n=4). Chordal cutting caused global LV dysfunction: E(es) (1.48+/-1.12 versus 0.98+/-1.30 mm Hg/mL, P=0.04) and PRSW (69+/-16 versus 60+/-15 mm Hg, P=0.03) decreased. Although heart rate and time from ED to ES were unchanged, time of mid-ejection was delayed (125+/-18 versus 136+/-19 ms, P=0.01). Globally, the LV apex and posterior PM tip were displaced away from the fibrous annulus and LV base-apex length increased at end-diastole and end-systole (all +1 mm, P<0.05). Locally, subendocardial end-diastolic strains occurred: Longitudinal strain (E22) 0.030+/-0.013 and radial thickening (E33) 0.081+/-0.041 (both P<0.05 versus zero). Subendocardial systolic shear strains were also perturbed: Circumferential-longitudinal "micro-torsion" (E12) (0.099+/-0.035 versus 0.075+/-0.025) and circumferential radial shear (E13) (0.084+/-0.023 versus 0.039+/-0.008, both P<0.05). CONCLUSIONS: Cutting second-order chords altered LV geometry, remodeled the myocardium between the PMs, perturbed local systolic strain patterns affecting micro-torsion and wall-thickening, and caused global systolic dysfunction, demonstrating the importance of these chordae for LV structure and function.

Animals↗
PubMed1980

Perspectives on systolic hypertension. The Framingham study.

Diastolic hypertension has been widely and justifiably accepted as a cause of cardiovascular mortality. However, it has also been accepted that the cardiovascular sequelae of hypertension derive chiefly from the diastolic component. Because systolic and diastolic pressure are usually highly correlated it is not easy to dissociate the effects of each. Statistical analysis suggests that systolic pressure is actually the more potent contributor to cardiovascular sequelae. Even isolated systolic pressure elevation is associated witn an excess cardiovascular mortality. At low diastolic pressures (i.e., less than 95 mm Hg), risk rises with the level of systolic pressure. Also, isolated systolic hypertension is most ominous in the elderly, in whom it is highly prevalent. Isolated systolic hypertension was related to the occurrence of "direct" complications as well as to atherosclerotic sequelae. It was also associated with excess mortality, taking into account rigid vessels as judged from pulse-wave recordings. Trials to determine whether the treatment of isolated systolic hypertension is efficacious for avoiding its demonstrated excess cardiovascular morbidity and mortality are urgently needed.

Adult↗
PubMed1981

The linearity of the end-systolic pressure-volume relationship in man and its sensitivity for assessment of left ventricular function.

The linearity and sensitivity of the end-systolic pressure-volume (P-Ves) relation to the inotropic state of the left ventricle were investigated in 11 patients with coronary heart disease and one patient with congestive cardiomyopathy. To minimize autonomic reflex responses, propranolol, 0.15 mg/kg, and atropine, 1 mg, were administered i.v. at the beginning of the study. Three ventriculograms were performed: at rest, after oral isosorbide dinitrate, 10 mg (systolic pressure decrease greater than or equal to 15 mm Hg), and during infusion of methoxamine, 2 mg/min (systolic pressure increase greater than or equal to 10 mm Hg). The three points of the Pv-Ves relation showed linearity (r greater than or equal to 0.96). The relation between the slope k of the P-Ves relation and the left ventricular ejection fraction at rest was best described by an exponential function (r = 0.94). The use of peak systolic pressure instead of end-systolic pressure showed equally good results. The intercept of the P-Ves line on the abscissa, which represents the theoretical end-systolic volume at zero pressure, was not related to the ejection fraction under control conditions. The P-Ves relation in postextrasystolic beats was displaced toward the left (smaller end-systolic volumes) and became steeper.

Atropine↗
PubMed1990

Assessment of abnormal systolic intraventricular flow patterns by Doppler imaging in patients with left ventricular dyssynergy.

Few data exist regarding the consequences of abnormalities of segmental contraction on intraventricular flow patterns. The development of color Doppler flow imaging has now permitted the visualization of intraventricular blood flow patterns. Therefore, we performed Doppler flow mapping in 41 patients (12 with normal left ventricular contraction, eight with hypokinesis or akinesis, and 21 with dyskinesis) and compared these findings with left ventriculography. Systolic blood flow by Doppler mapping in subjects with normal ventricular contraction was characterized primarily by flow through the left ventricular outflow tract and into the aorta. In patients with dyskinesis, paradoxical systolic flow toward the abnormal segment was present, and persisted for at least 50% of systole in 18 of 21 patients. Mean duration of paradoxical flow in dyskinetic patients was 77% of systole. Paradoxical flow was also observed in two of five patients with akinesis but in no patients with hypokinesis. A good correlation was observed between the duration of paradoxical systolic flow and indexes of regional wall motion (radian shortening of the involved myocardium) (r = 0.77) and global ejection fraction derived from cineangiography (r = 0.79). Correlations between the area of the paradoxical systolic flow stream in midsystole and indexes of left ventricular function were less close, with r equaling 0.57 for both regional wall motion and ejection fraction. Thus, paradoxical systolic flow can be detected in most patients with left ventricular dyskinesis, and correlates with the magnitude of regional and global left ventricular dysfunction by cineangiography.

Adult↗
PubMed2005

Modest salt reduction lowers blood pressure in isolated systolic hypertension and combined hypertension.

Many randomized trials have shown that a reduction in salt intake lowers blood pressure in hypertensive individuals. However, few have looked at the effects according to hypertension category. A recent analysis of the third and fourth National Health and Nutrition Examination Survey suggests that salt intake may not be related to blood pressure in isolated systolic or combined hypertension. To look at this further, we reanalyzed the data of our previous salt reduction trials. Hypertensive individuals were studied in randomized double-blind crossover studies: 1 month of usual salt intake compared with 1 month of reduced salt intake. In isolated systolic hypertension (n=24), blood pressure was reduced from 166+/-19/86+/-7 to 156+/-20/85+/-7 mm Hg (systolic P<0.001; diastolic P=0.459) with a reduction in urinary sodium from 175+/-51 to 87+/-38 mmol per 24-hour period (10.3 to 5.1 g per day of salt). In combined hypertension (n=88), blood pressure was reduced from 161+/-16/100+/-9 to 154+/-17/96+/-9 mm Hg (P<0.001) with a reduction urinary sodium from 176+/-65 to 98+/-51 mmol per 24-hour period (10.4 to 5.8 g per day of salt). These results demonstrate that salt reduction has a significant effect on blood pressure in isolated systolic and combined hypertension. The fall in systolic observed in isolated systolic hypertension would be predicted to reduce stroke by approximately one third, ischemic heart disease by one quarter, and heart failure by one quarter in the population between 60 and 80 years of age, in whom isolated systolic hypertension is the predominate form of hypertension and carries the highest risk. These results provide strong support for universal salt reduction in all hypertensives.

Adult↗
PubMed1991

Systolic blood pressure levels in black populations in sub-Sahara Africa, the West Indies, and the United States: a meta-analysis.

Average systolic blood pressure levels from epidemiological studies conducted on black populations in sub-Sahara Africa were pooled and compared with pooled systolic blood pressure levels from black populations in the northern portion of the Western hemisphere (the West Indies and the United States). Studies published in English that listed systolic blood pressure means and standard deviations and sample sizes in 40-49-year-old men and women were included. Overall, systolic blood pressure levels were higher (p less than 0.05) in blacks from the northern Western hemisphere than in blacks from sub-Sahara Africa for both men (12 mm Hg higher) and women (13 mm Hg higher). The analysis was also conducted on regions within sub-Sahara Africa and in rural and urban subgroups. Systolic blood pressure was lower (p less than 0.05) in East Africa than in the other three regions within Africa for both sexes. Overall, urban blacks within Africa had higher systolic blood pressures (p less than 0.05) than rural blacks for both sexes. In the northern Western hemisphere, rural blacks had higher systolic blood pressures (p less than 0.05) than urban blacks for both sexes. Studies should be designed with standardized methods to unravel these intraracial differences in blood pressure levels.

Adult↗
PubMed1995

Noninvasive ambulatory 24-hour blood pressure in patients with high normal blood pressure and exaggerated systolic pressure response to exercise.

Few studies have investigated the significance of abnormal increases in systolic pressure during exercise in patients with high normal blood pressure and its correlation with 24-hour ambulatory blood pressure monitoring and left ventricular structure. This study was performed in 30 sedentary subjects (42 +/- 4 years old) with high normal blood pressure. Fifteen subjects presenting < 220 mm Hg systolic pressure during ergometric exercise were compared with 15 others with systolic pressure > or = 220 mm Hg. Average 24-hour (systolic, 127 +/- 5 versus 142 +/- 4 mm Hg, P < .01; diastolic, 82 +/- 4 versus 92 +/- 3 mm Hg, P < .01), daytime (systolic, 130 +/- 6 versus 144 +/- 4 mm Hg, P < .01; diastolic, 84 +/- 4 versus 92 +/- 4 mm Hg, P < .01), and nighttime (systolic, 116 +/- 7 versus 132 +/- 6 mm Hg, P < .01; diastolic, 72 +/- 6 versus 85 +/- 6 mm Hg, P < .01) ambulatory blood pressure monitoring values were significantly higher in subjects with an exaggerated blood pressure response to exercise. No significant differences were observed in left ventricular morphology. These findings indicate that subjects presenting high normal blood pressure and exaggerated systolic pressure during exercise show significantly high ambulatory blood pressure monitoring values that are not associated with left ventricular hypertrophy.

Adult↗