Sistēmiskās hemodinamikas saistība ar maksimālo fiziskās slodzes asinspiedienu jauniem pieaugušajiem
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Latvijas Universitāte
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lav
Abstract
Sistēmiskās hemodinamikas saistība miera stāvoklī ar pārspīlētu asinsspiediena reakciju uz fizisku slodzi lielākoties nav zināma. Tāpēc jauniešu grupā tika pētīta sirds izsviedes un sistēmiskās asinsvadu pretestības saistība ar asinsspiediena reakciju uz fizisko slodzi. Pētījumā piedalījās 426 gados jauni pieaugušie, kas piedalījās notiekošajā Cardiovascular Risk in Young Finns Study. 2007. gadā tika izmērīta sistēmiskā hemodinamika (30-45 gadu vecumā), izmantojot visa ķermeņa impedances kardiogrāfiju, kā arī noteikts asinsspiediens miera stāvoklī, ķermeņa masas indekss, zema blīvuma lipoproteīnu holesterīna līmenis tukšā dūšā, augsta blīvuma lipoproteīnu holesterīna līmenis un triglicerīdi. Maksimālo kardiopulmonālās fiziskās slodzes testu ar asinsspiediena mērījumiem dalībnieki veica 2008. un 2009. gadā. Dalībniekiem ar augstu sistēmiskās asinsvadu pretestības indeksu (SVRI virs mediānas) bija augstāks sistoliskais un diastoliskais asinsspiediens miera stāvoklī (P=0,001). Maksimālais fiziskās slodzes asinsspiediens un sirdsdarbības frekvence bija paaugstināta augsta SVRI grupā (P<0,001 un P 0,006). Analizēs, kas koriģētas pēc vecuma un dzimuma, SVRI bija saistīts ar maksimālo fiziskās slodzes sistolisko spiedienu (P<0,001), savukārt sirds indeksam bija saistība ar maksimālo fiziskās slodzes sistolisko spiedienu (P=0,936). SVRI saglabājās būtiski saistīts ar maksimālo fiziskās slodzes sistolisko spiedienu arī pēc ķermeņa masas indeksa un asinsspiediena miera stāvoklī iekļaušanas modelī (P=0,006). Pēc tam, kad multivariantu modelī tika iekļauta maksimālā fiziskā slodze un maksimālā sirdsdarbības frekvence, SVRI joprojām bija nozīmīgi saistīts ar maksimālo fiziskās slodzes sistolisko asinsspiedienu (P=0,004). Pārspīlēta fiziskās slodzes asinsspiediena reakcija biežāk tika novērota pacientiem ar augstu SVRI nekā pacientiem ar zemu SVRI (P=0,002). Šis pētījums parādīja, ka SVRI neatkarīgi prognozē maksimālo fiziskās slodzes sistolisko asinsspiedienu un ka pārspīlēta fiziskās slodzes asinsspiediena reakcija biežāk bija novērojama personām ar augstu SVRI nekā personām ar zemu SVRI.
Association of resting systemic hemodynamics with exaggerated exercise blood pressure response are largely unknown. Therefore, the association of resting cardiac output and systemic vascular resistance with exercise blood pressure response was studied in the cohort of young adults. The study consisted of 426 young adults participating in the ongoing Cardiovascular Risk in Young Finns Study. In 2007, systemic hemodynamics were measured (at age 30-45 years) by whole-body impedance cardiography, and resting blood pressure, body mass index, fasting low- density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were measured. A maximal cardiopulmonary exercise test with blood pressure measurements was performed by participants in 2008-2009. Participants with high systemic vascular resistance index (SVRI above median) had higher resting systolic and diastolic blood pressure (P=0.001). The peak exercise blood pressure and heart rate were elevated in the high SVRI group (P<0.001 and P 0.006). In age- and sex-adjusted analyses, SVRI was associated with peak exercise systolic pressure (P<0.001), while cardiac index did have an association with peak exercise systolic pressure (P=0.936). SVRI remained significantly associated with peak exercise systolic pressure after inclusion of body-mass index and resting blood pressure into model (P=0.006). After further addition of maximal exercise capacity and peak heart rate into multivariable model, SVRI remained significantly associated with peak exercise systolic blood pressure (P=0.004). Exaggerated exercise blood pressure response was more frequently observed in patients with high SVRI than in patients with low SVRI (P=0.002). The present study showed that SVRI independently predicted maximal exercise systolic blood pressure, and that exaggerated exercise blood pressure response was more common in subjects with high SVRI than in those with low SVRI.
Association of resting systemic hemodynamics with exaggerated exercise blood pressure response are largely unknown. Therefore, the association of resting cardiac output and systemic vascular resistance with exercise blood pressure response was studied in the cohort of young adults. The study consisted of 426 young adults participating in the ongoing Cardiovascular Risk in Young Finns Study. In 2007, systemic hemodynamics were measured (at age 30-45 years) by whole-body impedance cardiography, and resting blood pressure, body mass index, fasting low- density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were measured. A maximal cardiopulmonary exercise test with blood pressure measurements was performed by participants in 2008-2009. Participants with high systemic vascular resistance index (SVRI above median) had higher resting systolic and diastolic blood pressure (P=0.001). The peak exercise blood pressure and heart rate were elevated in the high SVRI group (P<0.001 and P 0.006). In age- and sex-adjusted analyses, SVRI was associated with peak exercise systolic pressure (P<0.001), while cardiac index did have an association with peak exercise systolic pressure (P=0.936). SVRI remained significantly associated with peak exercise systolic pressure after inclusion of body-mass index and resting blood pressure into model (P=0.006). After further addition of maximal exercise capacity and peak heart rate into multivariable model, SVRI remained significantly associated with peak exercise systolic blood pressure (P=0.004). Exaggerated exercise blood pressure response was more frequently observed in patients with high SVRI than in patients with low SVRI (P=0.002). The present study showed that SVRI independently predicted maximal exercise systolic blood pressure, and that exaggerated exercise blood pressure response was more common in subjects with high SVRI than in those with low SVRI.