Systolic Blood Pressure During Recovery From Exercise and the Risk of Acute Myocardial Infarction in Middle-Aged Men

Chang

et al. 2016

JAHA

BackgroundThe structure of the aorta is considered to influence exercise systolic blood pressure (SBP) response, which, in turn, might impact upon adverse outcomes. The current study sought to investigate the relationship of aortic calcification and exercise SBP with adverse outcomes among elderly individuals.Methods and ResultsWe retrospectively reviewed 702 elderly individuals (>65 years of age) without obstructive coronary artery disease (CAD; luminal stenosis <50%) who underwent coronary computed tomography (CT) and exercise treadmill testing. ΔSBP stage2 and ΔSBP peak were defined as the difference in systolic blood pressure (SBP) between rest and stage 2 or peak exercise, respectively. Thoracic aortic calcium score (TACS) and coronary artery calcium score (CACS) were measured using CT scanning procedures. The primary endpoints were defined as all‐cause death, admission for heart failure, obstructive CAD requiring coronary intervention, and stroke. In multivariable models, ΔSBP stage2 and ΔSBP peak were positively related with log(TACS+1), even after adjusting for various clinical variables, baseline SBP, and CACS (P<0.001). During a median follow‐up period of 65 months, there were 59 events (8.4%). In a multivariate Cox regression model, independent predictors for all events were age (hazard ratio [HR], 1.12; 95% CI, 1.05–1.19; P<0.001), dyslipidemia (HR, 1.96; 95% CI, 1.14–3.37; P=0.015), and the 4th quartile of TACS (HR, 1.24; 95% CI, 1.03–1.49; P=0.024). Among individual events, the 4th quartile of TACS was the only independent predictor for stroke (HR, 2.15; 95% CI, 1.09–5.13; P=0.044), whereas CACS ≥400 mm3 was an independent predictor for obstructive CAD requiring intervention (HR, 7.04; 95% CI, 1.58–31.36; P=0.010).ConclusionsAortic calcification was related to SBP response during exercise and was an independent predictor for outcomes, especially stroke, regardless of resting SBP or CACS.

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confidence: 99%

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

Chang

et al. 2016

JAHA

“…This is in contrast to several other investigators who have found a relation between recovery blood pressure level and hypertension as well as myocardial infarction and cardiovascular death. 8,9,16,25,26 We had several missing values for SBP 4 min after exercise that can make the comparison with other variables difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Another way to find a suitable predictor for future hypertension and cardiovascular disease is to evaluate the blood pressure level at recovery. 8,16 The diversity in predictive values could be explained by differences in exercise test methods, the definition of the hypertensive reaction and study populations. Several investigations have been performed on healthy young or middle-aged males.…”

Section: Introductionmentioning

confidence: 99%

Exercise blood pressure and the risk of future hypertension

et al. 2011

The aim of this prospective cohort study was to identify which blood pressure measurement during exercise is the best predictor of future hypertension. Further we aimed to create a risk chart to facilitate the evaluation of blood pressure reaction during exercise testing. A number (n ¼ 1047) of exercise tests by bicycle ergometry, performed in 1996 and 1997 were analysed. In 2007 --2008, 606 patients without hypertension at the time of the exercise test were sent a questionnaire aimed to identify current hypertension. The response rate was 58% (n ¼ 352). During the 10 --12 years between exercise test and questionnaire, 23% developed hypertension. The strongest predictors of future hypertension were systolic blood pressure (SBP) before exercise (odds ratios (OR) 1.63 (1.31 --2.01) for 10 mm Hg difference) in combination with the increase of SBP over time during exercise testing (OR 1.12 (1.01 --1.24) steeper increase for every 1 mm Hg min À1 ). A high SBP before exercise and a steep rise in SBP over time represented a higher risk of developing hypertension. A risk chart based on SBP before exercise, increase of SBP over time and body mass index was created. SBP before exercise, maximal SBP during exercise and SBP at 100 W were significant single predictors of future hypertension and the prediction by maximal SBP was improved by adjusting for time/ power at which SBP max was reached during exercise testing. Recovery ratio (maximal SBP/SBP 4 min after exercise) was not predictive of future hypertension.

Clinical Journal of the American Society of Nephrology

“…In a populationbased sample of 1033 normotensive Japanese men, for example, exercise-induced increase in BP was a strong determinant of future hypertension (13). Both HR reactivity (27)(28)(29) and BP reactivity (14,15) in response to graded exercise are potent indicators of cardiovascular outcomes. Taken together, these data suggest that performing actigraphy and ABPM concomitantly may further enhance the prognostic information already contained in ambulatory BP recordings.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, in otherwise healthy individuals, the extent of increase in BP with physical activity is an independent predictor of incident hypertension (13). In those who are referred for exercise testing, BP reactivity is a marker of cardiovascular outcomes (14,15). Thus, it is logical to postulate that a higher level of physical activity over the long-term would foster a greater level of cardiovascular health.…”

mentioning

confidence: 99%

Physical Activity and Hemodynamic Reactivity in Chronic Kidney Disease

Agarwal

Light

2008

Background and objectives: Patients with chronic kidney disease (CKD) have an elevated cardiovascular risk. This study was designed to understand better the presence and strength of the relationship between physical activity and BP and to explore determinants of hemodynamic reactivity.Design, setting, participants, & measurements: Twenty-four patients with CKD (mean age 69.5 yr; 3.1 antihypertensive drugs; estimated GFR 47 ml/min per 1.73 m 2 , albumin/creatinine ratio 403 mg/g) were studied on three occasions during a 6-wk period with 24-h ambulatory BP monitoring and simultaneous activity monitoring with wrist actigraphy.Results: Nondippers were found have a greater level of sleep activity compared with dippers, although the awake activity level was similar (7.06 versus 6.73) between groups (P ‫؍‬ 0.042 for interaction). In 3587 BP activity pairs, hemodynamic reactivity was variable between individuals (systolic BP reactivity 1.06 [SD 10.50]; diastolic BP reactivity 0.89 [SD 7.80] heart rate reactivity 1.18 [SD 11.00]); those who were more sedentary had a greater increment in systolic BP compared with those who were less sedentary. Antihypertensive drugs blunted hemodynamic reactivity. Hemodynamic reactivity was greatest between 12 a.m. and 8 a.m., making this a vulnerable period for cardiovascular events.Conclusions: Greater hemodynamic reactivity in sedentary people with CKD offers a possible and thus far unrecognized mechanism of cardiovascular damage. Besides reducing BP, antihypertensive drugs reduce hemodynamic reactivity, which offers another plausible mechanism of cardiovascular protection with their use.