TY - JOUR
T1 - Blood pressure dynamics during exercise rehabilitation in heart failure patients
AU - Hecht, Idan
AU - Arad, Michael
AU - Freimark, Dov
AU - Klempfner, Robert
N1 - Publisher Copyright:
© European Society of Cardiology 2017.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background Patients suffering from heart failure (HF) may demonstrate an abnormal blood pressure response to exercise (ABPRE), which may revert to a normal one following medical treatment. It is assumed that this change correlates positively with prognosis and functional aspects. The aim of this study was to characterize patients with ABPRE and assess ABPRE normalization and the correlation with clinical and functional outcomes. Methods In the study, 651 patients with HF who underwent cardiac rehabilitation (CR) were examined. Patients who presented an ABPRE during stress testing were identified and divided into those who corrected their initial ABPRE following CR and those who did not. Results Pre-rehabilitation ABPRE was present in 27% of patients, 68% of whom normalized their ABPRE following CR. Two parameters were independently predictive of failure to normalize the blood pressure response: female gender (odds ratio (OR) 3.5; 95% confidence interval (CI) 1.4-9.0) and decreased systolic function (OR 3.2; 95% CI 1.0-9.4). Patients with hypertrophic cardiomyopathy demonstrated higher rates of ABPRE normalization than patients with other causes of HF (93% vs. 62%, respectively, P = 0.03). The research population exhibited an average improvement in exercise capacity (4.7 to 6.4 metabolic equivalents (METS), P <.001), ejection fraction (35.4% to 37.7%, P <.001) and percentage of patients with New York Heart Association (NYHA) class 3-4 (50% to 43.4%, P =.123). The group who normalized their ABPRE exhibited greater improvement. Conclusions Amongst a population of patients suffering from HF, an ABPRE was normalized following CR in two thirds of patients. Female gender and a reduced systolic function independently predicted the failure to correct the ABPRE, while patients with hypertrophic cardiomyopathy demonstrated exceptionally high rates of normalization.
AB - Background Patients suffering from heart failure (HF) may demonstrate an abnormal blood pressure response to exercise (ABPRE), which may revert to a normal one following medical treatment. It is assumed that this change correlates positively with prognosis and functional aspects. The aim of this study was to characterize patients with ABPRE and assess ABPRE normalization and the correlation with clinical and functional outcomes. Methods In the study, 651 patients with HF who underwent cardiac rehabilitation (CR) were examined. Patients who presented an ABPRE during stress testing were identified and divided into those who corrected their initial ABPRE following CR and those who did not. Results Pre-rehabilitation ABPRE was present in 27% of patients, 68% of whom normalized their ABPRE following CR. Two parameters were independently predictive of failure to normalize the blood pressure response: female gender (odds ratio (OR) 3.5; 95% confidence interval (CI) 1.4-9.0) and decreased systolic function (OR 3.2; 95% CI 1.0-9.4). Patients with hypertrophic cardiomyopathy demonstrated higher rates of ABPRE normalization than patients with other causes of HF (93% vs. 62%, respectively, P = 0.03). The research population exhibited an average improvement in exercise capacity (4.7 to 6.4 metabolic equivalents (METS), P <.001), ejection fraction (35.4% to 37.7%, P <.001) and percentage of patients with New York Heart Association (NYHA) class 3-4 (50% to 43.4%, P =.123). The group who normalized their ABPRE exhibited greater improvement. Conclusions Amongst a population of patients suffering from HF, an ABPRE was normalized following CR in two thirds of patients. Female gender and a reduced systolic function independently predicted the failure to correct the ABPRE, while patients with hypertrophic cardiomyopathy demonstrated exceptionally high rates of normalization.
KW - Heart failure
KW - blood pressure response to exercise
KW - cardiac rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85019150810&partnerID=8YFLogxK
U2 - 10.1177/2047487317690951
DO - 10.1177/2047487317690951
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C2 - 28169556
AN - SCOPUS:85019150810
SN - 2047-4873
VL - 24
SP - 818
EP - 824
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 8
ER -