Author + information
- Mustafa Aparci1,
- Murat Yalcin2,
- Zafer Isilak2,
- Zekeriya Arslan3,
- Omer Uz2,
- Cengiz Ozturk4 and
- Ejder Kardesoglu2
Prehypertension is a clinical condition in which initiation of antihypertension therapy other than lifestyle modification was disputable. Additionally there is not a provocative test which could clarify whether the blood pressures innocently continue below the high normal ranges. Moreover, aortic diameter which is out of the normal visual perspective such as the ascending aorta is generally overlooked during an chocardiographic examination at parasternal long axis view. So we aimed to evaluate the aortic diameters measured at ascending aorta in pre-hypertensive patients and to analyze the systolic and diastolic blood pressure and also heart rate response during the initiation, stage 0, 1, 2 and 3 and recovery period of treadmill test.
We retrospectively evaluated the medical recordings including aortic root and ascending aorta from the echocardiographic examination report and systolic and diastolic blood pressure and heart rate responses measured at initiation, 1st, 2nd, 3rd stage and recovery period of treadmill test. We excluded the subjects with coronary artery disease, hypertension, congestive heart failure, and aortic aneurysm (ascending aorta ≥40 mm) from the study. We compared those measurements obtained from the treadmill test among groups designed according diameter of ascending aorta ≤35 mm (normal subjects) and >35 mm (subjects with aortic dilatation).
Age of study groups was not statistically different. Comparison of mean diameter of aortic root and ascending aorta was as follows (32.8±1.49 vs 32.9±1.27, p=0.69) and (34.5±0.96 vs 35.9±1.0, p=0.00), respectively. When we compared the SBP, DBP and HR responses during TT we observed that SBP tended to increase to a higher state in pre-hypertensive subjects with dilated aorta compared to ones with normal aorta (Figure 1). However there was not such a tendency to increase in DBP and HR in those subjects. Also heart rates were surprisingly lower in those subjects at the initial period. Increased pressure to aortic baroreceptor might have been probably caused the heart rate to be reflexively reduced.
Imaging of ascending aorta is clinically essential for guiding the antihypertensive therapy in pre-hypertensive subjects. Exaggerated systolic blood pressure response during TT may probably be responsible for that aortic dilatation in those subjects. Our findings may be a rationale for initiation of an anti-hypertensive therapy preferentially the beta blocking drug in pre-hypertensive subjects with aortic dilatation.