Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study. Circulation 2012 Jun 12;125(23):2836-43
Date
05/11/2012Pubmed ID
22572915Pubmed Central ID
PMC3636551DOI
10.1161/CIRCULATIONAHA.111.063933Scopus ID
2-s2.0-84862131572 (requires institutional sign-in at Scopus site) 134 CitationsAbstract
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 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 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 flow-mediated dilation 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.
Author List
Thanassoulis G, Lyass A, Benjamin EJ, Larson MG, Vita JA, Levy D, Hamburg NM, Widlansky ME, O'Donnell CJ, Mitchell GF, Vasan RSAuthor
Michael E. Widlansky MD Associate Director, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Blood Flow Velocity
Blood Pressure
Brachial Artery
Cohort Studies
Exercise
Exercise Test
Female
Humans
Hypertension
Hypertrophy, Left Ventricular
Male
Manometry
Massachusetts
Middle Aged
Multivariate Analysis
Risk Factors
Ultrasonography
Vascular Stiffness
