High blood pressure during and after exercise may be markers for later disease

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Higher blood pressure during exercise and delayed blood pressure recovery after exercise are associated with a higher risk of hypertension, pre-clinical and clinical cardiovascular disease and death among middle-aged to older adults. Blood pressure responses to exercise are significant markers of cardiovascular disease and mortality risk in young to middle-aged adults. However, few studies have examined the associations of midlife blood pressure responses to sub-maximal (less than the maximum of which an individual is capable) exercise with the risk of cardiovascular outcomes and mortality in later life.

Researchers from Boston University School of Medicine (BUSM) evaluated the association of blood pressure changes and recovery with indicators of pre-clinical disease among participants from the Framingham Heart Study (average age 58 years, 53% women). They then followed these participants to assess whether these blood pressure changes were associated with the risk of developing hypertension, cardiovascular disease or dying.

They observed that both higher exercise systolic blood pressure (SBP) and exercise diastolic blood pressure (DBP) were associated with a greater risk of developing hypertension. Additionally, both delayed SBP and DBP recovery after exercise were associated with higher risk of cardiovascular disease and death.

“The way our blood pressure changes during and after exercise provides important information on whether we will develop disease in the future; this may help investigators evaluate whether this information can be used to better identify people who are at higher risk of developing hypertension and CVD, or dying later in life,” explained corresponding author Dr Vanessa Xanthakis, assistant professor of medicine and biostatistics at BUSM and an investigator for the Framingham Heart Study.

Xanthakis recommends that people know their blood pressure numbers, speak to their physician regarding changes during and after exercise and follow a healthy lifestyle (including a regular physical activity schedule) to help lower risk of disease later in life.

Abstract
Background: Few studies examined the associations of midlife blood pressure (BP) responses to submaximal exercise with the risk of cardiovascular outcomes and mortality in later life.
Methods and Results: We evaluated 1993 Framingham Offspring Study participants (mean age, 58 years; 53.2% women) attending examination cycle 7. We related BP responses to submaximal exercise with prevalent subclinical cardiovascular disease (CVD) using multivariable linear regression models. We also related BP responses to submaximal exercise to the incidence of hypertension, CVD, and all‐cause mortality using Cox proportional hazards regression models. Each SD increment of exercise BP was associated with higher log‐transformed left ventricular mass (systolic blood pressure [SBP], β=0.02, P=<0.001; diastolic blood pressure [DBP], β=0.01, P=0.004) and carotid intima‐media thickness (SBP, β=0.08, P=<0.001). Rapid BP recovery (per 1 SD increment) was associated with lower log left ventricular mass (SBPrecovery; β=−0.03, P=<0.001) and carotid intima‐media thickness (SBPrecovery, β=−0.07, P=0.003; DBPrecovery, β=−0.09, P=0.003). Additionally, Each SD increment of exercise BP was associated with a higher risk of incident hypertension (SBP, hazard ratio [HR], 1.40; 95% CI, 1.20–1.62; DBP, HR, 1.24; 95% CI, 1.11–1.40) and CVD (DBP, HR, 1.15; 95% CI, 1.02–1.30). Finally, the multivariable‐adjusted HR for each 1‐SD increment of BP recovery was 0.46 (SBPrecovery, 95% CI, 0.38–0.54) and 0.55 (DBPrecovery, 95% CI, 0.45–0.67) for hypertension; 0.80 (SBPrecovery, 95% CI, 0.69–0.93) for CVD; and 0.76 (SBPrecovery, 95% CI, 0.65–0.88) for all‐cause mortality.
Conclusions: Higher submaximal exercise BP and impaired BP recovery after submaximal exercise in midlife may be markers of subclinical and clinical CVD and mortality in later life.

Authors
Joowon Lee, Ramachandran S Vasan, Vanessa Xanthakis

 

Boston University School of Medicine material

 

Journal of the American Heart Association abstract

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