Respuesta hipertensiva durante un ejercicio submáximo en escalón como prueba diagnóstica de hipertensión arterial
DOI:
https://doi.org/10.17533/udea.iatreia.158Palabras clave:
Diagnóstico , Ejercicio , Hipertensión , Presión Arterial , Sensibilidad y EspecificidadResumen
Introducción: la respuesta hipertensiva al ejercicio (RHE) se asocia con alteraciones en mecanismos que controlan la presión arterial (PA). Aunque se sabe de su valor pronóstico, la evidencia de su validez diagnóstica es limitada.
Objetivo: evaluar las características operativas de la RHE para detectar la presencia de hipertensión arterial (HTA).
Métodos: estudio transversal de validez de una prueba diagnóstica que incluyó personas de ambos sexos, con edades entre 40 a 60 años, con sospecha de alteraciones de la PA. Se definió una RHE por cifras de PA sistólica mayores de 150 mmHg luego de la prueba del escalón de Dundee. La presencia de HTA se definió con monitoreo ambulatorio de la presión arterial de 24 horas.
Resultados: se incluyeron 124 pacientes con edad promedio de 50,5 ± 5,9 años. El 54 % fueron mujeres. La frecuencia de RHE fue del 57,3 %, mientras que de HTA fue del 78,2 %. La RHE tuvo una sensibilidad del 59,8% (IC 95 % 49,5 a 70,1), especificidad del 51,9 % (IC 95 % 31,2 a 72,6), valor predictivo positivo del 81,7 % (IC 95 % 72,0 a 91,4), valor predictivo negativo del 26,4 % (IC 95 % 13,6 a 39,2), LR+ de 1,2 (IC 95 % 0,8 a 1,9) y LR- de 0,8 (IC 95 % 0,5 a 1,2), para detectar la presencia de HTA.
Conclusión: la RHE, durante un esfuerzo submáximo en escalón, no presenta buenas características operativas para detectar HTA en pacientes de edad media con sospecha de alteraciones de la PA. Por tal razón, no se recomienda como método de diagnóstico.
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(1) Jellinger PS. American Association of Clinical Endocrinologists/American College of Endocrinology Management of Dyslipidemia and Prevention of Cardiovascular Disease Clinical Practice Guidelines. Diabetes Spectr. 2018;31(3):234-45. DOI 10.2337/ds18-0009.
(2) Mancia G. Short- and long-term blood pressure variability: present and future. Hypertension. 2012;60(2):512-7. DOI 10.1161/HYPERTENSIONAHA.112.194340.
(3) Millar-Craig MW, Bishop CN, Raftery EB. Circadian variation of blood-pressure. Lancet. 1978;1(8068):795-7.
(4) O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31(9):1731-68. DOI 10.1097/HJH.0b013e328363e964.
(5) Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-324. DOI 10.1161/HYP.0000000000000066.
(6) Farrell PA, Joyner MJ, Caiozzo VJ. ACSM's Advanced Exercise Physiology. 2 nd. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
(7) Kim D, Ha JW. Hypertensive response to exercise: mechanisms and clinical implication. Clin Hypertens. 2016;22:17. DOI 10.1186/s40885-016-0052-y.
(8) Schultz MG, Sharman JE. Exercise Hypertension. Pulse (Basel). 2014 May;1(3-4):161-76. DOI 10.1159/000360975.
(9) Sharman JE, Boutouyrie P, Perier MC, Thomas F, Guibout C, Khettab H, et al. Impaired baroreflex sensitivity, carotid stiffness, and exaggerated exercise blood pressure: a community-based analysis from the Paris Prospective Study III. Eur Heart J. 2018;39(7):599-606. DOI 10.1093/eurheartj/ehx714.
(10) Moore MN, Climie RE, Otahal P, Sharman JE, Schultz MG. Exercise blood pressure and cardiac structure: A systematic review and meta-analysis of cross-sectional studies. J Sci Med Sport. 2021 Sep;24(9):925-930. DOI 10.1016/j.jsams.2021.02.014.
(11) Lim P, Shiels P, Anderson J, MacDonald T. Dundee step test: a simple method of measuring the blood pressure response to exercise. J Hum Hypertens. 1999;13(8):521-6.
(12) Schultz MG, Otahal P, Cleland VJ, Blizzard L, Marwick TH, Sharman JE. Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis. Am J Hypertens. 2013;26(3):357-66. DOI 10.1093/ajh/hps053.
(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):1507-12.
(14) Lim PO, Donnan PT, MacDonald TM. Does the Dundee Step Test predict outcome in treated hypertension? A sub-study protocol for the ASCOT trial. Anglo-Scandinavian Cardiac Outcome Trial. J Hum Hypertens. 2000 Jan;14(1):75-8. DOI 10.1038/sj.jhh.1000931.
(15) Lim PO, Shiels P, MacDonald TM. The Dundee Step Test: a novel exercise test suitable for the outpatient management of hypertension. J Hypertens. 1998;16(11):1701.
(16) Schultz MG, Otahal P, Picone DS, Sharman JE. Clinical Relevance of Exaggerated Exercise Blood Pressure. J Am Coll Cardiol. 2015 Oct 20;66(16):1843-1845. DOI 10.1016/j.jacc.2015.08.015.
(17) 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 Mar;7(3):234-41. DOI 10.1093/ajh/7.3.234.
(18) Singh JP, Larson MG, Manolio TA, O'Donnell CJ, Lauer M, Evans JC, et al. Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study. Circulation. 1999;99(14):1831-6. DOI 10.1161/01.CIR.99.14.1831.
(19) 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):848-53. DOI 10.1016/j.jacc.2003.08.057.
(20) Yang WI, Kim IJ, Kim MS, Kim SH, Moon JY, Sung JH, et al. Association of elevated blood pressure during exercise with cerebral white matter lesions. Blood Press. 2018;27(3):166-72. DOI 10.1080/08037051.2018.1423544.
(21) Giang KW, Hansson PO, Mandalenakis Z, Persson CU, Grimby G, Svardsudd K, et al. Long-term risk of stroke and myocardial infarction in middle-aged men with a hypertensive response to exercise: a 44-year follow-up study. J Hypertens. 2021;39(3):503-10. DOI 10.1097/HJH.0000000000002668.
(22) Percuku L, Bajraktari G, Jashari H, Bytyci I, Ibrahimi P, Henein MY. Exaggerated systolic hypertensive response to exercise predicts cardiovascular events: a systematic review and meta-analysis. Pol Arch Intern Med. 2019;129(12):855-63. DOI 10.20452/pamw.15007.
(23) Barlow PA, Otahal P, Schultz MG, Shing CM, Sharman JE. Low exercise blood pressure and risk of cardiovascular events and all-cause mortality: systematic review and meta-analysis. Atherosclerosis. 2014;237(1):13-22. DOI 10.1016/j.atherosclerosis.2014.08.029.
(24) Lim PO, Donnan PT, MacDonald TM. How well do office and exercise blood pressures predict sustained hypertension? A Dundee Step Test Study. J Hum Hypertens. 2000;14(7):429-33. DOI 10.1038/sj.jhh.1001041.
(25) Jackson AS, Pollock ML. Practical Assessment of Body Composition. Phys Sportsmed. 1985;13(5):76-90. DOI 10.1080/00913847.1985.11708790.
(26) Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153-6. DOI 10.1016/s0735-1097(00)01054-8.
(27) Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873-934. DOI 10.1161/CIR.0b013e31829b5b44.
(28) Kokkinos P, Pittaras A, Narayan P, Faselis C, Singh S, Manolis A. Exercise capacity and blood pressure associations with left ventricular mass in prehypertensive individuals. Hypertension. 2007;49(1):55-61. DOI 10.1161/01.HYP.0000250759.71323.8b.
(29) Schultz MG, Picone DS, Nikolic SB, Williams AD, Sharman JE. Exaggerated blood pressure response to early stages of exercise stress testing and presence of hypertension. J Sci Med Sport. 2016;19(12):1039-42. DOI 10.1016/j.jsams.2016.04.004.
(30) Bramlage P, Deutsch C, Kruger R, Wolf A, Muller P, Zwingers T, et al. Validation of the custo screen 400 ambulatory blood pressure-monitoring device according to the European Society of Hypertension International Protocol revision 2010. Vasc Health Risk Manag. 2014;10:303-9. DOI 10.2147/VHRM.S63602.
(31) Wei W, Tolle M, Zidek W, van der Giet M. Validation of the mobil-O-Graph: 24 h-blood pressure measurement device. Blood Press Monit. 2010;15(4):225-8. DOI 10.1097/MBP.0b013e328338892f.
(32) Huang QF, Yang WY, Asayama K, Zhang ZY, Thijs L, Li Y, et al. Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension. Hypertension. 2021;77(2):254-264. DOI 10.1161/HYPERTENSIONAHA.120.14591.
(33) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013;310(20):2191-4. DOI 10.1001/jama.2013.281053.
(34) Mert KU, Sener E, Yilmaz AS, Mert GO, Yetmis F, Dural M, et al. The association of exaggerated hypertensive response to exercise and beta-blockers use in hypertensives. Clin Exp Hypertens. 2020;42(8):707-13. DOI 10.1080/10641963.2020.1779284.
(35) Schultz MG, Hare JL, Marwick TH, Stowasser M, Sharman JE. Masked hypertension is "unmasked" by low-intensity exercise blood pressure. Blood Press. 2011;20(5):284-9. DOI 10.3109/08037051.2011.566251.
(36) Sharman JE, Hare JL, Thomas S, Davies JE, Leano R, Jenkins C, et al. Association of masked hypertension and left ventricular remodeling with the hypertensive response to exercise. Am J Hypertens. 2011;24(8):898-903. DOI 10.1038/ajh.2011.75.
(37) Leitao CB, Canani LH, Kramer CK, Boza JC, Pinotti AF, Gross JL. Masked hypertension, urinary albumin excretion rate, and echocardiographic parameters in putatively normotensive type 2 diabetic patients. Diabetes Care. 2007;30(5):1255-60. DOI 10.2337/dc06-2131.
(38) Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47(5):846-53. DOI 10.1161/01.HYP.0000215363.69793.bb.
(39) Sega R, Trocino G, Lanzarotti A, Carugo S, Cesana G, Schiavina R, et al. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: Data from the general population (Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study). Circulation. 2001;104(12):1385-92. DOI 10.1161/hc3701.096100.
(40) Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527. DOI 10.1136/bmj.h5527.
(41) Knottnerus JA, Buntinx F. The Evidence Base of Clinical Diagnosis. Theory and methods of diagnostic research. 2nd ed. Oxford (UK): Blackwell Publishing Ltd; 2009.
(42) Smith BE, Madigan VM. Understanding the Haemodynamics of Hypertension. Curr Hypertens Rep. 2018;20(4):29. DOI 10.1007/s11906-018-0832-8.
(43) Mahajan S, Gu J, Lu Y, Khera R, Spatz ES, Zhang M, et al. Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance. Am J Med. 2020;133(4):e127-e139. DOI 10.1016/j.amjmed.2019.08.042.
(44) Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Kränkel N, et al. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol. 2021;zwaa141. DOI 10.1093/eurjpc/zwaa141.
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