Abstract
PurposeDynamic exercise results in increased systolic blood pressure (BP). Irrespective of resting BP, some individuals may experience exaggerated rise in systolic BP with exercise, which in adulthood is associated with risk of hypertension, and cardiovascular (CV) disease. It is unknown if exercise BP is associated with markers of CV structure during adolescence. We examined this question in a large adolescent cohort taking account of the possible confounding effect of body composition and BP status. Methods4036 adolescents (mean age 17.8 ± 0.4 years, 45% male), part of a UK population-based birth cohort study completed a sub-maximal step-test with BP immediately post-exercise. Sub-samples underwent comprehensive echocardiography for assessment of cardiac structure; arterial structure including aortic pulse wave velocity (PWV) and carotid intima-media thickness; and assessment of body composition by dual-energy X-ray absorptiometry (DXA). ResultsEach 5 mm Hg higher post-exercise systolic BP was associated with CV structure, including 0.38 g/m2.7 (95% CI: 0.29, 0.47) greater left-ventricular mass index (LVMI), and 0.04 m/s (95% CI: 0.03, 0.04) greater aortic PWV. Adjustment for age, total body fat, lean mass and BP status attenuated, but did not abolish associations with LVMI (0.14 g/m2.7 per 5 mm Hg of post-exercise systolic BP; 95% CI 0.21, 0.39) or aortic PWV (0.03 m/s per 5 mm Hg of post-exercise systolic BP; 95% CI: 0.02, 0.04). ConclusionSubmaximal exercise systolic BP is associated with markers of CV structure in adolescents. Given the clinical relevance of exercise BP in adulthood, such associations may have implications for CV disease screening in young people and risk in later life.
Highlights
Dynamic incremental exercise increases the metabolic needs of active musculature, resulting in a normal stepwise elevation to systolic blood pressure (BP) with increasing exercise intensity
Schultz et al / International Journal of Cardiology 275 (2019) 152–157 explains a large amount of the variance in adolescent cardiac structure, we sought to examine the potential influence of body composition assessed by dual-energy X-ray absorptiometry (DEXA) on associations between exercise BP and cardiovascular structure
Please note that the study website contains details of all the data that is available through a fully searchable data dictionary. For this cross-sectional analysis, eligible participants included 4036 individuals (45% male) who completed a sub-maximal exercise step test with BP measurement immediately post-exercise at the Avon Longitudinal Study of Parents and Children (ALSPAC) 17-year follow-up. This was the only wave of ALSPAC in which a sub-sample of individuals had detailed cardiovascular assessments including cardiac echocardiography (n = 2102), carotid-femoral pulse wave velocity (PWV) measurements (n = 3582), and carotid intima-media thickness (IMT) measures (n = 3746)
Summary
Dynamic incremental exercise increases the metabolic needs of active musculature, resulting in a normal stepwise elevation to systolic BP with increasing exercise intensity. Excessive elevation in systolic BP with acute exercise, ‘exaggerated exercise blood pressure (EEBP)’ is associated with heightened levels of cardiovascular disease (CVD) risk, independent of resting BP. ☆ The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. ⁎ Corresponding author at: Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart 7000, Australia. M.G. Schultz et al / International Journal of Cardiology 275 (2019) 152–157 explains a large amount of the variance in adolescent cardiac structure, we sought to examine the potential influence of body composition (total fat and lean body mass) assessed by dual-energy X-ray absorptiometry (DEXA) on associations between exercise BP and cardiovascular structure
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