Relations of Exercise Blood Pressure Response to Cardiovascular Risk Factors and Vascular Function in the Framingham Heart Study

Abstract

Background Exercise blood pressure (BP) is an important marker of left ventricular hypertrophy, incident hypertension and future cardiovascular events. Although impaired vascular function is hypothesized to influence the BP response during exercise, limited data exist on the association of vascular function with exercise BP in the community. Methods and Results Framingham Offspring cohort participants (n=2115, 53% women, mean age 59 years) underwent a submaximal exercise test (first 2 stages of the Bruce protocol), applanation tonometry and brachial artery flow-mediated dilation (FMD) testing. We related exercise systolic and diastolic BP at second stage of the Bruce protocol to standard cardiovascular risk factors and to vascular function measures. In multivariable linear regression models, exercise systolic BP was positively related to age, standing BP, standing heart rate, smoking, body mass index, and the total cholesterol-to-high-density cholesterol (HDL) ratio (p≤0.01 for all). Similar associations were observed for exercise diastolic BP. Carotid-femoral pulse wave velocity (p=0.02), central pulse pressure (p<0.0001), mean arterial pressure (p=0.04) and baseline brachial flow (p=0.002) were positively associated with exercise systolic BP, whereas FMD was negatively associated (P<0.001). For exercise diastolic BP, forward pressure wave amplitude was negatively related (p<0.0001) whereas mean arterial pressure was positively related (p<0.0001). Conclusions Increased arterial stiffness and impaired endothelial function are significant correlates of a higher exercise systolic BP response. Our findings suggest that impaired vascular function may contribute to exaggerated BP responses during daily living, resulting in repetitive increments in load on the heart and vessels and increased cardiovascular disease risk.

Midlife exercise blood pressure, heart rate, and fitness relate to brain volume 2 decades later

“…It has been postulated that the microvasculature of the brain is particularly vulnerable to the excessive fluctuations in BP, 28 as a consequence of vascular dysfunction 15 and poor CV fitness. 10 The current investigation revealed that higher DBP response to a submaximal exercise test in midlife was associated with smaller brain volume in later life.…”

“…29,33 Individuals with exaggerated BP response to low levels of exercise may have vascular dysfunction that may not be discernable with examination of resting BP. 15 There is also growing evidence that ambulatory BP is more strongly associated with functional and structural brain impairments than resting BP measured in a clinical setting. 34,35 Exercise BP may be an early warning of changes in vascular stiffness that only become evident in later life.…”

“…11,12 Poor CV fitness and vascular dysfunction exaggerate fluctuations in blood pressure (BP) and heart rate (HR) during lowlevel exercise. [13][14][15] Therefore, the hemodynamic response to low-level exercise may unmask underlying vascular dysfunction and poor CV fitness. Exaggerated exercise hemodynamics has been associated with target organ damage 16 in relation to CV disease (CVD), 17 but the association of midlife exercise hemodynamics and fitness with late-life brain structure has not been explored.…”

Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification

“…An exaggerated exercise SBP response is also associated with other established cardiovascular risk factors, such as insulin resistance, hypercholesterolemia, and carotid atherosclerosis 7, 8, 9. Arterial stiffening has also been proposed as a potential mechanism for an elevated exercise SBP response observed during both peak10 and submaximal exercise intensities 11…”

Lipid-lowering, cardiovascular and anti-inflammatory effects of «Letium» in patients with hypertension

“…оригіНальНе ДосліДжеННя ХС (ОХС) и ХС липопротеидов низкой плотности (ХСЛПНП). Установлено, что уровень ОХС в крови является не только независимым предиктором по-вышения ДАД, а и существенно превосходит по сво-ей прогностической значимости такие ФРС СО как Ож и возраст (13).…”