GENERALISED MICROVASCULAR DYSFUNCTION IS NONLINEARLY ASSOCIATED WITH HIGHER EXERCISE BLOOD PRESSURE – THE MAASTRICHT STUDY

Abstract

Objective: Exercise blood pressure (BP), both high and low responses, is associated with the development of cardiovascular disease and all-cause mortality. However, it is unclear whether microvascular dysfunction is a determinant of exercise BP. Therefore, we investigated whether microvascular dysfunction was (nonlinearly) associated with exercise BP. Design and method: In the population-based Maastricht Study (n = 1,688; age 59 ± 8 years; 51% men), generalised microvascular dysfunction was constructed by a composite score of features of cerebral small vessel disease, retinal microvascular features, albuminuria, heat-induced skin hyperaemia and plasma biomarkers of microvascular dysfunction. Similarly, we constructed a composite score of exercise systolic BP and diastolic BP by combining BP at moderate workload, at peak exercise, change per minute and at 4 minutes after recovery. We used linear regression with adjustments for age, sex, lifestyle and cardiovascular risk factors, including resting BP. Nonlinearity was investigated by adding a quadratic term of generalised microvascular dysfunction Results: After adjustments, generalised microvascular dysfunction was nonlinearly associated with both the composite score of exercise SBP and DBP in an inverted U-shape fashion (p-nonlinear for exercise SBP < .001; for exercise DBP .001). When we divided microvascular dysfunction into quintiles, exercise SBP and DBP did not become higher after the middle quintile, and plateaued or were lower in the highest quintiles of microvascular dysfunction. Conclusions: Generalised microvascular dysfunction is nonlinearly associated with higher exercise SBP and DBP in an inverted U-shape fashion. These findings support the hypothesis that generalised microvascular dysfunction is a determinant of both high and low exercise BP responses.