EXERCISE TOLERANCE IN OUT-WARD PATIENTS WITH ARTERIAL HYPERTENSION

Introduction: Decreased exercise tolerance is manifested as chronic heart failure (CHF)with/without dyspoe, ortopnoic position during night (OP) or sexual dysfunction (SD).  We analysed relationship of tolerance of up-stairs climbing with risk markers in pts with arterial hypertension (AH).
Methods: Multicentric study STAIRS consisted of 3353 pts (M=1664 (49,6%), F=1689 (50.4%) with moderate AH with mean BP=154,4±14.1/92,5±8.3 mmHg, overweighted (BMI= 28.9±4,6) in middle age 60.0±12.9 yrs. Decreased tolerance of  ≤19 stairs without dyspnoe was present in 40.6% pts, OP during night  in 21,2% pts, nykturia in 27.1% pts and self reported SD in 13,4% pts. Cardiometabolic risk was defined as obesity or abdominal obesity (IDF 2005) or DM 2.
Results: Females tolerated less stairs (25.8 vs. 31.8; p=0.001) as males. CHF pts (n=169) tolerated less stairs (18.8 vs. 29.2; p=0.001), as AH pts,  but improved more after antihypertensive therapy (11.1 vs 4.2; p=0.001). Considering ≤19 stairs as cutt off point, OR for diagnosis of CHF was 2.14 (1.50-3.06; p=0.001), but ≤19 stairs as a test for identification of CHF it demonstrates low senzitivity: 0.42 (0.40-0.56) and moderate specificity: 0.75 (0.73-0.76). Positive predictive value is only 0.26 (0.25-.28), but negative predictive value reached 0.74 (0.72-0.76). Other factors demonstrated higher ORs:  OP: 3.2 (2.67-3.87); p=0.001,  nykturia: 3.08 (2.58-3.69); p=0.001, SD = 2.31 (1.84-2.90); p=0.001. 
Obese pts (34.4% pts) tolerate less stairs but  perceive, surprisingly, same SD (16.4% vs 16.9%);(NS) as non-obese pts.  Abdominal obesity directly correlates with SD (rho=0.08; p=0.001) and with nykturia (rho=0.04; p= 0.028). DM pts expressed only trend to SD.

Conclusion: Number of tolerated stairs and other tolerance related factors could be clinically informative for diagnosis of chronic heart failure in arterial hypertension patients.