Exercise Systolic Blood Pressure at Moderate Workload Is Linearly Associated With Coronary Disease Risk in Healthy Men

Abstract

There is no consensus on the definition of an exaggerated increase in systolic blood pressure (SBP) during exercise. The aim was to explore a potential threshold for exercise SBP associated with increased risk of coronary heart disease (CHD) in healthy men, using repeated exercise testing. 2,014 healthy Caucasian male employees were recruited into the Oslo Ischemia Study during early 1970s. At follow-up seven years later, 1,392 men were still considered healthy. A bicycle exercise test at 100W workload was performed at both visits. Cox regression analyses were performed with increasing cutoff levels of peak SBP during 100W workload (SBP100W) from 160 mmHg to 200 mmHg, adjusted for cardiovascular risk factors and physical fitness. Participants with SBP100W below cutoff level at both baseline and first follow-up were compared to participants with SBP100W equal to or above cutoff level at both visits. Compared to participants with SBP100W below all cutoff levels between 165-195 mmHg, CHD risk was increased amongst participants with SBP100W equal to or above cutoff at all levels. There was no evidence of a distinct threshold level for CHD risk, and the relation between SBP100W and CHD appears linear. When investigating exercise SBP at moderate workload measured at two exercise tests in healthy middle-aged Caucasian men, there is increasing risk of coronary disease with increasing exercise SBP independent of SBP at rest. The association is linear from the low range of exercise SBP and there is no sign of a distinct threshold level for increased coronary disease risk. Participants were divided into groups defined by SBP100W at Visit 1 and Visit 2 (Figure S1). Group 1 includes participants with SBP100W below cutoff level at both Visit 1 and Visit 2. Group 3 includes participants with SBP100W equal to or above cutoff level at both Visit 1 and 2, and Group 2 includes participants with SBP100W equal to or above cutoff level at only one of the two visits, regardless of which. To investigate the risk of CHD, we performed Cox regression analyses adjusted for age, resting SBP, total serum cholesterol, smoking status and family history of CHD. We also performed additional analyses adjusting for physical fitness. Physical fitness was defined as total workload during the exercise test measured in kilojoules divided by body weight. Due to the increases in cutoff levels, the number of participants in each group successively changed in each analysis, as Group 1 expanded and Group 3 diminished.

Longitudinal blood pressure patterns and cardiovascular disease risk

“…However, it remains unclear which of these novel indices is the most accurate predictor of incident CVD, as head-to-head data from outcome studies are lacking. In addition to longitudinal BP indices covered by this review, BP measurements taken during exercise and antihypertensive therapy could also provide incremental predictive value over conventional "present" BP [66][67][68]. Nevertheless, until additional data become available, more emphasis should be put on assessing the clinical feasibility of these BP indices.…”

Association of lifetime blood pressure with adulthood exercise blood pressure response: the cardiovascular risk in young Finns study

“…Despite that, high BP response to exercise appears to predict future development of hypertension in young athletes even after adjustment with resting BP [7]. Interestingly, Mariampillai et al recently reported that exercise systolic BP at moderate workload is linearly associated with coronary disease risk in healthy middle-aged men independently of resting BP [29]. Altogether, it appears that even though EEBP may be a physiological compensatory mechanism at least in welltrained athletes, it may also reveal failing compensatory mechanisms or hypertensive tendency beyond resting BP.…”

Vital capacity and valvular dysfunction could serve as non-invasive predictors to screen for exercise pulmonary hypertension in the elderly based on a new diagnostic score

“…Furthermore, we chose 100W analogous to the suggested workload to define and assess non-invasive exercise hypertension (or exaggerated blood pressure response) during bicycle ergometry. 24 ExRHC was performed on a bicycle ergometer directy after the resting measurements, either in patients without (<25 mm Hg) or moderately elevated mPAP (25-35 mm Hg) at rest. PH at rest was defined according to the suggestions of the Task Force of the 6th World Symposium on Pulmonary Hypertension, during which the mPAP threshold was lowered to 20 mm Hg.…”

“…100W has also been suggested as a threshold to determine exaggerated (peripheral) blood pressure response during regular bicycle ergometry. 24 Furthermore, peak performance of 100W was deemed to represent sufficient cardiorespiratory fitness for our elderly population. With higher workload, the probability of exPH may further decrease, represented by decreasing exmPAP, exPAWP and exPVR.…”