Obesity is the primary risk factor for essential hypertension, and patients with obesity-related hypertension exhibit higher rates of cardiovascular morbidity and mortality. Exercise-induced weight loss has become an effective therapeutic approach for these patients. However, cardiopulmonary function and blood pressure dynamics during different exercise phases in this population remain unclear.

To investigate the characteristics of cardiopulmonary function in obesity-related hypertensive patients across different BMI categories during various exercise stages, and to explore the relationship between cardiopulmonary exercise parameters and conventional left ventricular structural indices.

A total of 625 patients diagnosed with essential hypertension at the General Medicine Department/Hypertension Center/Cardiac Rehabilitation Center of Yan'an Hospital Affiliated to Kunming Medical University from January 2020 to July 2023 were retrospectively recruited. Participants were stratified into three groups based on the BMI: control group (n=209, 18.5 kg/m²< BMI <24.0 kg/m²), overweight hypertension group (n=210, 24.0 kg/m²≤ BMI <28.0 kg/m²), and obesity-related hypertension group (n=206, BMI≥28.0 kg/m²). Systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen uptake (VO₂), percentage of predicted VO₂ (VO₂%), VO₂ per kilogram (VO₂/kg), oxygen pulse (O₂ pulse), heart rate (HR) during cardiopulmonary exercise testing, and echocardiographic indices such as interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left ventricular mass (LVM), and left ventricular mass index (LVMI) at different exercise phases were recorded.

Peak-exercise SBP was significantly higher in the obesity-related hypertension and overweight hypertension groups compared to the control group (P<0.05). Peak-exercise O₂ pulse, VO₂, and anaerobic threshold VO₂ were significantly higher in the obesity-related hypertension group than those of the overweight hypertension and control groups (P<0.05). Conversely, peak-exercise VO₂/kg, VO₂%, and anaerobic threshold VO₂/kg, VO₂% were significantly lower in the obesity-related hypertension group than those of the overweight and control groups (P<0.05). Peak-exercise O₂ pulse was positively correlated with LVMI and BMI (r=0.098, 0.283; P<0.05). Peak-exercise VO₂/kg and VO₂% were negatively correlated with BMI (r=-0.372, -0.291; P<0.05). Peak-exercise SBP was positively correlated with BMI, LVM, and LVMI (r=0.069, 0.221, 0.151; P<0.05) .

Obesity-related hypertension patients exhibit reduced exercise cardiac function and exercise tolerance compared to normal-weight individuals. Higher BMI is associated with elevated peak-exercise SBP, O₂ pulse, LVM, and LVMI, suggesting abnormal increases in cardiac preload and afterload post-exercise. These physiological changes may contribute significantly to LVMI progression. Integrating cardiopulmonary exercise testing parameters with LVMI provides more precise cardiac function assessment for obesity-related hypertension.

肥胖是原发性高血压的第一危险因素，肥胖相关性高血压患者的心血管疾病发生率与死亡率更高，运动减重是这类患者的有效治疗方法，但目前该类患者在不同运动阶段的心肺功能、血压变化等情况尚不明确。

探讨不同BMI下，肥胖相关性高血压患者在不同运动阶段心肺功能的特点，以及心肺运动功能与常规左心室结构参数之间的关系。

回顾性选取2020年1月—2023年7月在昆明医科大学附属延安医院全科医学科/高血压中心/心脏康复中心确诊为原发性高血压的患者625例为研究对象，依据BMI分为对照组209例（18.5 kg/m²<BMI<24.0 kg/m²）、超重高血压组210例（24.0 kg/m²≤BMI<28.0 kg/m²）、肥胖高血压组206例（BMI≥28.0 kg/m²）。统计分析心肺运动试验中不同运动阶段的收缩压（SBP）、舒张压（DBP）、摄氧量（VO₂）、摄氧量/预计值%（VO₂%）、公斤摄氧量（VO₂/kg）、氧脉搏（O₂ pulse）、心率（HR）以及心脏彩超中的室间隔厚度（IVST）、左心室舒张末期内径（LVEDd）、左心室质量（LVM）、左心室质量指数（LVMI）等指标。

肥胖高血压组及超重高血压组运动高峰期SBP高于对照组（P<0.05）；肥胖高血压组运动高峰期的O₂ pulse、VO₂及无氧阈VO₂高于超重高血压组，高于对照组。肥胖高血压组运动高峰期VO₂/kg、VO₂%及无氧阈VO₂/kg、VO₂%低于超重高血压组，超重高血压组低于对照组（P<0.05）。运动高峰期O₂ pulse与LVMI、BMI呈正相关（r=0.098、0.283，P<0.05）。运动高峰期VO₂/kg、VO₂%与BMI呈负相关（r=-0.372、-0.291，P<0.05）。运动高峰期SBP与BMI、LVM、LVMI呈正相关（r=0.069、0.221、0.151，P<0.05）。

肥胖相关性高血压患者运动心功能、运动耐量较体质量正常者更低；BMI越大，运动高峰SBP、O₂ pulse越高、LVM、LVMI越大，这些特点提示该类型患者运动后心脏前后负荷异常增加，这些运动生理学的变化可能成为LVMI增加的重要原因。心肺运动试验指标与LVMI结合，可为肥胖相关性高血压患者提供更加准确的心功能评估数据。