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Blood pressure response to exercise in unaffected relatives of autosomal dominant polycystic kidney disease patients: an observational study

  • Nephrology - Original Paper
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Abstract

Introduction

Hypertension is an early finding of autosomal dominant polycystic kidney disease (ADPKD) and is related to different mechanisms. Cyst expansion-related renin secretion or early endothelial dysfunctions are some of these hypotheses. In addition, the underlying genetic factor is thought to play a role in the inheritance of hypertension. The differential course of hypertension in ADPKD preoccupies that relatives of ADPKD patients may also be at risk for this underlying mechanisms with a genetically determined abnormal endothelial-vascular state. In this study, we aimed to evaluate blood pressure response to exercise as an initial vascular problem in unaffected and normotensive relatives of hypertensive ADPKD patients.

Methods

This is an observational study including unaffected and normotensive relatives (siblings and children) of ADPKD patients (relative group) and healthy controls (control group) who performed an exercise stress test. A 6-lead electrocardiogram was recorded and blood pressure was measured automatically with a cuff worn on the right arm, immediately before the test and every 3 min during the exercise and the recovery phase. Participants continued the test until their age-specific target heart rate was reached or symptoms occurred that required discontinuation of the test. The highest blood pressure and pulse values during exercise were noted. In addition, as a marker for endothelial function, nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels were measured at baseline and post-exercise.

Results

There were 24 participants in the relative group (16 female, mean age 38.45 years) and 30 participants in the control group (15 female, mean age 37.96 years). Two groups were similar in terms of age, gender, body mass index (BMI), smoking status, resting systolic blood pressure (SBP)/diastolic blood pressure (DBP) and biochemical parameters. Mean SBP and DBP were similar in both groups during 1st, 3rd and 9th minutes of exercise (1st minute: 136.25 ± 19.71 mmHg vs 140.36 ± 30.79 mmHg for SBP, p = 0.607, 84.05 ± 14.75 mmHg vs 82.60 ± 21.60 mmHg for DBP, p = 0.799; 3rd minute: 150.75 ± 30.39 mmHg vs 148.54 ± 27.30 mmHg for SBP, p = 0.801, 98.95 ± 26.92 mmHg vs 85.92 ± 17.93 mmHg for DBP, p = 0.062; 9th minute: 156.35 ± 30.84 mmHg vs 166.43 ± 31.90 mmHg for SBP, p = 0.300, 96.25 ± 21.99 mmHg vs 101.78 ± 33.11 mmHg for DBP, p = 0.529 for control and relatives, respectively). During the recovery phase, SBP decreased in both groups in 6th minute (119.85 ± 14.06 mmHg vs 122.86 ± 16.76 mmHg, p = 0.538 for control and relatives respectively); however, in the relatives of ADPKD patients DBP remained high at the end of the 6th minute (78.95 ± 11.29 mmHg vs 86.67 ± 9.81 mmHg p = 0.025 for control and relatives, respectively). Baseline and post-exercise NO and ADMA levels were similar in both groups (Baseline p = 0.214 and p = 0.818, post-exercise p = 0.652 and p = 0.918 for NO and ADMA, respectively).

Conclusion

Abnormal blood pressure response to exercise was observed in unaffected normotensive relatives of ADPKD. Although its clinical significance needs to be demonstrated by additional research, it is an important finding that unaffected relatives of ADPKD may be at risk for an altered arterial vascular network. Furthermore, these data are the first to demonstrate that relatives of ADPKD patients may also be under risk with a genetically determined abnormal vascular state.

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Data availability

We declare data availability upon request.

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Funding

The authors declared that this study has received no financial support.

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Authors and Affiliations

  1. Ankara Sehir Hastanesi, Ankara, Turkey

    Ezgi Coskun Yenigun, Didem Turgut, Simal Koksal Cevher & Fatih Dede

  2. Gülhane EAH, Ankara Gulhane Egitim ve Arastirma Hastanesi, Ankara, Turkey

    Cigdem Yucel

  3. Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi, Saglik Bilimleri Universitesi Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi, Ankara, Turkey

    Cenk Aypak

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All the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version.

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Correspondence to Ezgi Coskun Yenigun.

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Ethical approval

Informed consent was obtained from all the participants and the study protocol was approved by the local Medical Ethics Committee of Health Sciences University, Ankara Numune Education and Research Hospital (decision no. 1570/2017; 08.11.2017). The study was conducted in accordance with the 2013 Helsinki Declaration and its later amendments or comparable ethical standards.

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Yenigun, E.C., Turgut, D., Cevher, S.K. et al. Blood pressure response to exercise in unaffected relatives of autosomal dominant polycystic kidney disease patients: an observational study. Int Urol Nephrol 55, 2313–2319 (2023). https://doi.org/10.1007/s11255-023-03535-y

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  • DOI: https://doi.org/10.1007/s11255-023-03535-y

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