A Study of association of TMT parameters with 24-Hour Ambulatory Blood Pressure findings in newly diagnosed hypertensive patients

SM Sharma; Dinesh Gautam; Shubham Singhal

Volume : VIII, Issue : VII, July - 2019

A Study of association of TMT parameters with 24-Hour Ambulatory Blood Pressure findings in newly diagnosed hypertensive patients

Sm Sharma, Dinesh Gautam, Shubham Singhal

Abstract :

Introduction: It has been reported that the lack of nocturnal BP fall which is called nondipping is associated with more serious end organ damages when compared to hypertensives with a dipping pattern. This study was done to evaluate associations between the extent of nocturnal dipping in blood pressure and physical capacity parameters like Exercise capacity (METs), Maximal heart rate (MHR), Heart Rate Recovery in 1st min post exercise (HRR–1), Heart Rate Reserve(HR) assessed through a standard cardiovascular treadmill stress test. Methods: This is a hospital based observational study. 140 Men and non– pregnant women with newly diagnosed were recruited. All the subjects underwent the 24–h ambulatory blood pressure (BP) assessment. The patient population was then divided into two groups based on their results of ABPM i.e Dippers and Non Dippers. All the individuals of both the groups underwent Treadmill Stress Test. Comparison of parameters of treadmill test (METs, HRR–1, MHR, HR) were made using appropriate statistical tests between the two groups. Results: On the basis of ABPM the study population was divided into two groups i.e. Dipper (n=66) and Non Dippers (n=74). The Dipper and Non Dipper groups were similar to each other with respect to age, gender distribution, smoking status, LVEF and s.creatinine levels. Non –Dippers (n=74) had a significantly higher Maximal Heart Rate on exercise (156.8 vs 146.4, p <0.05) and Heart Rate Reserve (74.01 vs 67.7 p<0.05) which is the difference of maximal heart rate (MHR) and baseline heart rate (BHR).Mean HRR–1 values (28.64 vs 22.84 bpm, P=.007) were significantly higher in dipper group than the hypertensive ⁄nondipper group. Conclusion: Blunting of the nocturnal fall of BP in hypertensives associates with a delayed recovery of heart rate after graded maximal exercise suggesting that a general decrease of vagal modulation within an abnormal sympathovagal response is present. That may indicate that in hypertensives without signs of coronary disease the decrease of vagal activity is linked to the failure of nighttime fall of BP that might represent an alteration of the autonomic nervous drive with possible deleterious consequences of a greater deterioration of target organs.