Browse > Article
http://dx.doi.org/10.4070/kcj.2016.46.3.394

Obesity and Hypertension in Association with Diastolic Dysfunction Could Reduce Exercise Capacity  

Kim, JinShil (Gachon University College of Nursing)
Kim, Myeong Gun (Department of Internal Medicine, Gachon University Gil Medical Center)
Kang, SeWon (Dongseoi University College of Nursing)
Kim, Bong Roung (Department of Internal Medicine, Seoul Medical Center)
Baek, Min Young (Department of Internal Medicine, Gachon University Gil Medical Center)
Park, Yae Min (Department of Internal Medicine, Gachon University Gil Medical Center)
Shin, Mi-Seung (Department of Internal Medicine, Gachon University Gil Medical Center)
Publication Information
Korean Circulation Journal / v.46, no.3, 2016 , pp. 394-401 More about this Journal
Abstract
Background and Objectives: Empirical evidence is lacking on the cumulative disease burden of obesity and hypertension and its impact on cardiac function and exercise capacity. The purpose of this study was to determine whether the presence of obesity and hypertension together was associated with cardiac dysfunction and exercise capacity. Subjects and Methods: Using a retrospective study design, medical records were reviewed for echocardiographic and treadmill exercise stress test data. Subjects were grouped according to four categories: normal control, obese, hypertensive, or obese and hypertensive. Results: Obese, hypertensive persons showed significantly lower Ea and E/A ratio and greater E/Ea ratio, deceleration time, left ventricular (LV) mass, and LV mass index compared to their counter parts (normal control, obese and/or hypertensive) (all p<0.05), after controlling for age and sex. After controlling for age and sex, significant differences in exercise capacity indices were found, with the obese group having shorter exercise time, lower metabolic equivalents, and lower maximal oxygen uptake than the normal control, hypertensive, or both groups (all p<0.05). The hypertensive or obese and hypertensive group had greater maximal blood pressure compared with the normal control group (all p<0.001). Obese and hypertensive persons were approximately three times more likely to have diastolic dysfunction (odd ratio=2.96, p=0.001), when compared to the reference group (normotensive, non-obese, or hypertensive only persons). Conclusion: Diastolic dysfunction was associated with obesity and/or hypertension. The cumulative risk of obesity and hypertension and their impact on diastolic dysfunction which could be modifiable could reduce exercise capacity.
Keywords
Obesity; Hypertension; Echocardiography; Diastolic function; Exercise capacity;
Citations & Related Records
Times Cited By KSCI : 3  (Citation Analysis)
연도 인용수 순위
1 Mendis S, Puska P, Norrving B. Global atlas on cardiovascular disease prevention and control [Internet]. Geneva: World Health Organization; 2011 April [cited 2015 May 18]. Available from http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf.
2 Korean National Health and Nutrition Examination Survey (KNHANES V-3). Ministry of Health & Welfare/Korea Centers for Disease Control & Prevention (2012). Rep. No. 11758 (December. 24, 2013).
3 Melis RJ, van Eijken MI, Teerenstra S, et al. A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study). J Gerontol A Biol Sci Med Sci 2008;63:283-90.   DOI
4 Centers for Disease Control and Prevention. Fact sheet: Health disparities in hypertension and hypertension control [Internet]. Atlanta: Centers for Disease Control and Prevention; 2011 April [cited 2015 March 18]. Available from http://www.cdc.gov/minorityhealth/CHDIR/2011/FactSheets/Hypertension.pdf.
5 Ministry of Health & Welfare: High salt intake in Korea [Internet]. Sejong: Ministry of Health & Welfare; 2012 November [cited 2015 May 25]. Available from http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=279051&page=1.
6 Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014;129:e28-292.   DOI
7 Tobe SW, Moy Lum-Kwong M, Von Sychowski S, Kandukur K, Kiss A, Flintoft V. Hypertension management initiative prospective cohort study: comparison between immediate and delayed intervention groups. J Hum Hypertens 2014;28:44-50.   DOI
8 Stuart-Shor EM, Berra KA, Kamau MW, Kumanyika SK. Behavioral strategies for cardiovascular risk reduction in diverse and underserved racial/ethnic groups. Circulation 2012;125:171-84.   DOI
9 So AY, Kim YM, Kim EY, et al. Effects of community-based case management program for clients with hypertension. J Korean Acad Nurs 2008;38:822-30.   DOI
10 Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63(25 Pt B):2960-84.   DOI
11 Ministry of Health and Welfare Statistics Portal. Prevalence of chronic dieseases [Internet]. Daejeon: Ministery of Health & Welfare; 2012 March [2015 March 13]. Available from: http://stat.mw.go.kr/front/statData/majorIdctView.jsp?menuId=17&guidSeq=112&ctgr=F00001.
12 Rhee SY, Park SW, Kim DJ, Woo J. Gender disparity in the secular trends for obesity prevalence in Korea: analyses based on the KNHANES 1998-2009. Korean J Intern Med 2013;28:29-34.   DOI
13 Hwang LC, Bai CH, Sun CA, Chen CJ. Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan. Asia Pac J Clin Nutr 2012;21:227-33.
14 Bradshaw PT, Monda KL, Stevens J. Metabolic syndrome in healthy obese, overweight, and normal weight individuals: the Atherosclerosis Risk in Communities Study. Obesity (Silver Spring) 2013;21:203-9.   DOI
15 Arkin JM, Alsdorf R, Bigornia S, et al. Relation of cumulative weight burden to vascular endothelial dysfunction in obesity. Am J Cardiol 2008;101:98-101.   DOI
16 Messerli FH, Sundgaard-Riise K, Reisin ED, et al. Dimorphic cardiac adaptation to obesity and arterial hypertension. Ann Intern Med 1983;99:757-61.   DOI
17 Ryu SK, Choi JW, Cho YB. The early change of left ventricular function in overweight and obese patients: analysis with tissue doppler echocardiography. Korean Circ J 2008 2008;38:270-5.   DOI
18 de Simone G, Kitzman DW, Chinali M, et al. Left ventricular concentric geometry is associated with impaired relaxation in hypertension: the HyperGEN study. Eur Heart J 2005;26:1039-45.   DOI
19 Canepa M, Sorensen LL, Pozios I, et al. Comparison of clinical presentation, left ventricular morphology, hemodynamics, and exercise tolerance in obese versus nonobese patients with hypertrophic cardiomyopathy. Am J Cardiol 2013;112:1182-9.   DOI
20 Seto S, Kapuku GK, Kawahara F, Suzuki S, Yano K. Influence of mild to moderate obesity on left ventricular stress filling pattern in hypertension. Hypertens Res 1998;21:245-50.   DOI
21 Chockalingam A, Linden MA, Del Rosario M, Govindarajan G, Dellsperger KC, Thomas TR. Exercise and weight loss improve exercise capacity independent of cardiac function in metabolic syndrome. Angiology 2010;61:192-7.   DOI
22 WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.   DOI
23 Oh JK, Park SJ, Nagueh SF. Established and novel clinical applications of diastolic function assessment by echocardiography. Circ Cardiovasc Imaging 2011;4:444-55.   DOI
24 Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002;40:1531-40.   DOI
25 Grewal J, McCully RB, Kane GC, Lam C, Pellikka PA. Left ventricular function and exercise capacity. JAMA 2009;301:286-94.   DOI
26 Kim HK, Kim YJ, Chung JW, Sohn DW, Park YB, Choi YS. Impact of left ventricular diastolic function on exercise capacity in patients with chronic mitral regurgitation: an exercise echocardiography study. Clin Cardiol 2004;27:624-8.   DOI
27 Baynard T, Carhart RL Jr, Ploutz-Snyder LL, Weinstock RS, Kanaley JA. Short-term training effects on diastolic function in obese persons with the metabolic syndrome. Obesity (Silver Spring) 2008;16:1277-83.   DOI
28 Fenk S, Fischer M, Strack C, et al. Successful weight reduction improves left ventricular diastolic function and physical performance in severe obesity. Int Heart J 2015;56:196-202.   DOI
29 Hess DR. Retrospective studies and chart reviews. Respir Care 2004;49:1171-4.