K002 What causes exercise induced breathlessness in hypertensive patients?

P

S

F

A

1

1

1

:

K O

K

O O

WO CE C ER T S I HEON U PIS R HRA D W T IAX SA EE L NN DD R I A YI E S O A D SF B I O T SRE RU T IE H N AC Y C T PL H E L II S H Y Y P M PA AP E TP R T O TA I M E T I SN I I E TC V TAE N ,J D J J iR P M a Sh h p s e al h nT a h n i ui d n4 c i a * gF Pmi L P S o alRo iM S o M N Y C ec N d h ii _ o c oN e it &i eyt ei s l fe H a Mo nnr ro U C mo o s n p e v s ye t ea r sunSchool, f sUniversity t tofoDundee, g i u hDundee, r DD19SY, oo g United rm n l aa e e aln i d pi y t d se f s ve u Kingdom. nc l o c h eo p di i m o e ce n d as r te lt d i hy yM s f p s f rei ( hu r a ntdoExercise c inducedhypervesttilation em c r ntw t t s has i i been iea F oo o n nnl o s f et i y hi d ays mawociated e p e withthe tsh en cseverityofr systolicheartfailureas ot u t t i l e ira f n i s woi s e i an m w h e vd a t i r i a a i gmindicatedby derh eincreasedcarbon p t en dioxi& o na t i r cg gs r o p a o t n - va ventilatoty equivalent c r o a i nme W n t t o ss cr h r ea r (slopeof eto cVe/C02). n re a r Thisphenomenon t u la v eis i also i sl f e g t e e o b r r ptttk?lt? n emi oi t d w de M i a he t w a s pe e sPreSmtitl o t withSyS@lliC c F tied h shypatemr i “on s n ra e t oe et m d f Ei i c w aoh mi 1e s bc c a t itasignificance tr te o iai l3 o 9(27make) o gi0 i rr n an c m where isd unclear. Westudied o h h t p y eo h t p w a n ere r rt re eeymptomatic o dt ihypertem wa ei ivesubjects t fnritewitha mean s sm h n i m t e ev t untreated c mo o s n f e O vt y 1u h ea s nnage h ofs 49 yeara(SD t ct i u Each e underwent t o r nia ls a e o l i 12). maximal d m b eo p d pr n ea er o s v e r fimitedtreadmillcerdiopuhnonety F csi s m or s aex~iee u ie e t s b d il s~ptom r eP w ld m a w eo t ( + 7t i p otestrng i iusingbreathby nrl e s breath e e respiratory h F gee i analysis; sdnt 5 p s sr t . ee v 4 + y P O a h s h B A l . r i echocauiiography; b is 1 n 0 g gn a h P h 5 r t . 4 m 1 24-hourambulatory Bs Po monitoring l s l i mmHg] l ci o d f d i a eu ( L ai e vn ac ef n [ABPM t 144(13)/93(11) t o f aud rie spirometry. E o l nWefound o ln e c is t l ( w o i 3 o t bw n h m a b As h o e between a i Ve/COZ a aodage,gender, r3 rt )o v F u m t e s n e nocorrelation smoking w d m ( Oe P h w Ep ai . habite,office, r0 oexerciseor t e 0ambulatory i F iP bloodpressure s t a 5e / s f i 6 o t nent% m ( v 1 P O o 1b s 8 . 5i a w F+ 0 sm + 0 3e u i 3 0 % < h l 1 ld r m e l v a m e si f un r m et n e r ac m e F Pn w a d ma h l o b W t c n i a i o S ro e d F r a wi nt A ma t l ae s e he c o hi oo d r c n a ti r de adn l i r s t o ae g o E s l( vi n r a o l x m e hg aa o mn a et e r ipt i s or l c cns l ai )ug e Wa a i en n P O I m a u m . a l an h r tw a 0 i d lv fley g w a5a s s y a e nr if t rg
M

E

D

F RD

I

K K

e

W

~

d

h

y

s

d ~ s

c

f

i a uu

yf

H c

W

r

a d

a

n

E

S

i DioxideVentilator so g Equivalent tr a ct tc o i t o

n

op l

h n i

K O

K S M S G H

C E IR A E B B I I L E D H - S TY C— C A D l S Ai C & M i Jh V B E A Mr A i Mg U Aa U y N p D e e a e Mn r

R

I

U

a p T g m c ( d b r 1 g b c

o t bi y

H

s

C

w

B

t d

S

an

s

S

R

A N L U IL T AT E TER A N I T S E A “ cc r or Ma r r a d , T b la u Ke l e ea a r r ,t t s l mi t o oe n gn H

M

ES ST

CC

c t e r iO e ht su r l o a t ho vu e e ea d m s coc h ir b p h ry o s y m m h psa pi l ut es o i en t a e n t si s r e ai r b tn t m m a d a t c p ot t lp hr eo t ( n is f i M e e t ci n a)s ( E r i nH s fa i v a i br - pt a na hm ey i v mE ol b e i pd tr mdro tt f -6nmo or bm ae et c t da ei t y r t ce t h bgai s a e ft rm a 5 t 6 ey w n t de e b g rd em p e r a s r d n at n , t c rvr b pe m o n oi e ni w sntit m a a nm e av nt p se in vts r s a t t h t i s r oi c n M n s R e ecI a e c r l gum e eut nm i a db v r e eeg r a l t d yai n m c r n of ab b e p ae nl c b f r eM a b t r el e Rr el a sap rdc )tao ro r a aa , v f 6m e t p v c y ( 2 A eo i t r T s p ya r 4 t y pab D he nb s rlp o - so ) t e nc p ye r o , m w a i w p o i ta p e c P ah ru r eD ea teMf dO m I hi o n ame i l tn e y i io mil e( r r c m 1 h l a e recruited f?om the mt fs i t 3 p ( e a 5 ya et m i ehigher buh 8p al e r e gd h s n ro a ns ac p e s1 al xi M ( R l R en g L rne ) n s ( t hsie %e t ao m i 3 do sp u bc et 1 8m i i it I T p t rt e - sa r b o b x aet I c e dd i h eg d d f u r e(o i snn ) b t t s ti . e c e ( 5 c a aa c4 me 7 t a zi / oss 9l s a +m m aM i w n dc a e ~m - e s1 t i mc l u 4 a f / s c br f m b f v e ( 8 e rC d 7 l re 0p ~ ndo b5 w m ~ ~ s i pa e 1t 2l i e o s g 8o ~ r n Praervirtg cerebral b f r ( 4 e lI 5 a 1l m ea ou 3 ~a m e % v8 p p a t p t e ha d l ho b xc ti i e ns hn b en tn t , i ec e a dt t ih ( el E igI eoEv i b oi T

a

O 0

LN R OO VR E AM E OS P E ME B O PR N D P Y oe e e e rr m z u gr n qi u N E H M u p tD ra ie i r noU M I -A V

l y i ,

c

aoe

(174+13/103~9 vs 16@13/99~7mmHg) and24hABpM values @45~15/91~11 141~15/91~9 mmHg),bhmtednocturnal fall Of

S

(

v 1 L f l i s i c w f o s l i a s ap c h

l

g d c o s b e K

m

h

A

D

r

m

w

w e

m

d ab w t w aw m a M a lp

c t

1

W C

T

T

c G w

e (

(

t P s

h

a tmh 6 i r o h B i H k g0gO * yht n c c ) e e Pr 8 r G ( fg gi M P 0 ~I 1 ( g3 . i / 1 5 v O 0 h G3 (0 m ~ 0 1e w 2 ~ 1 2v r e a R P8r 0m N a i (i 1o k m e 3fr 9t . gn h0 u e 3 nv l 2r 0 n ea & vt 1r i O riM t sf o rc o f yyp a e t n p a a e 6 tmas c e i n ( l pe t ci cuo ea e s r f r s adlnr b o bt a v ei s r l n u ne i n ua dm ut a W co lo ot n = e C cn P ht r f hh a dc i r ar m b tr ti e n na e d pH tpv- n r o tm ac e ame yi v E lm m Mr - t f i ida c e t ey r s a t e r b p d a e t c M p ei ea r rh o b s er le R ds e i e eou ob o n c nr I t n t ai w tti y m w b e b p c tb f t t m rf l l l eo b o a ar tr eo e w a ln d d a‘ e i p su n e i xa r p ro dh r i o o oi i v af r b s ic i se u l l t a V

c

p

B

E

m P

aM

H

~

yI b

r no

l u

pp ns e

e l

p

i p

t

r s a ot

f

r

o

t

t

b

to s

e r

no ro

otu

s i r

,

i nr