Association of Blood Pressure Responses to Submaximal Exercise in Midlife With the Incidence of Cardiovascular Outcomes and All-Cause Mortality: The Framingham Heart Study.

Abstract

BackgroundFew 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 ResultsWe 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 (SBP recovery; β=−0.03, P=<0.001) and carotid intima‐media thickness (SBP recovery, β=−0.07, P=0.003; DBP recovery, 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 (SBP recovery, 95% CI, 0.38–0.54) and 0.55 (DBP recovery, 95% CI, 0.45–0.67) for hypertension; 0.80 (SBP recovery, 95% CI, 0.69–0.93) for CVD; and 0.76 (SBP recovery, 95% CI, 0.65–0.88) for all‐cause mortality.ConclusionsHigher 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.