노인 고혈압 환자에서 운동 중의 과도한 혈압상승 반응에 대한 결정요인

Abstract

Objective: The elderly patients who have hypertension and consequently high cardiovascular risk are increasing and require an appropriate medical management. An exaggerated elevation of blood pressure (BP) during exercise, which is related to arterial stiffness and aging, has been reported to predict clinical outcome. This study was conducted to identify the determinants of exaggerated hypertensive response during exercise in elderly hypertensive patients. Methods: One hundred and five hypertensive patients above 65 year-old, who took antihypertensive medications more than 2 weeks and with controlled resting BP (≤140/90 mmHg), were included. Demographic data and medications were obtained from interview and medical records. The patients then underwent a symptom-limited treadmill exercise testing. Clinical determinants for exaggerated hypertensive response (systolic BP ≥210 mmHg in male, ≥190 mmHg in female) at 5~7 METS exercise were identified by multiple logistic regression analysis. Results: Eighteen patients (17%) showed exaggerated hypertensive response during exercise. Female gender, diabetes mellitus, higher resting pulse rate, number of anti-hypertensive drugs, calcium channel blocker use and diuretic use were significantly associated with exaggerated hypertensive response. After adjusting for confounding variables, female gender (P=0.04), diabetes mellitus (P=0.01), calcium channel blocker use (P=0.01) and diuretic use (P=0.01) remained as independent determinants for the exaggerated response.