Maximal Exercise Systolic Blood Pressure Research Articles

Excessive Blood Pressure Rise and Cardiovascular Remodeling in Marathon Runners.

Exercise-induced hypertension (EIH) is thought to be associated with increased cardiovascular (CV) risks. However, no previous studies have investigated the effects of EIH on CV systems in marathon runners without CV risk factors using both 24-hr ambulatory blood pressure (BP) monitoring and exercise stress echocardiography (ESE). This study firstly described differences in CV adaptations according to EIH assessed by both exams. Marathon runners between 35 and 64 years of age without CV risk factors were eligible. All the participants underwent both 24-hr ambulatory BP monitoring and ESE. EIH was defined as a maximal exercise systolic BP≥210 mmHg. The EIH group (n=19) had shorter training history and higher exercise intensity compared to the non-EIH group (n=23). The average systolic BP was higher in the EIH group than in the non-EIH group. Left cardiac chamber size and left ventricular mass (LVM) were also higher in the EIH group compared to the non-EIH group. Maximal BP during ESE was positively correlated with both parameters. Exaggerated BP response during exercise needs to be monitored for pre-emptive measurements before it results in progressive cardiovascular maladaptation.

Exercise-induced hypertension can increase the prevalence of coronary artery plaque among middle-aged male marathon runners.

Marathon runners demonstrate a high incidence of coronary artery plaque; however, studies on runners with exercise-induced hypertension (EIH) are sparse. We aimed to investigate the prevalence of coronary artery plaque among marathon runners with EIH.Veteran male marathon runners (≥40 and <60 years) underwent an exercise stress test. They were divided into 2 groups: normal blood pressure group (NBPG, n = 22), with resting systolic blood pressure (SBP)/diastolic blood pressure <140/90 mm Hg and maximal exercise SBP <210 mm Hg, and EIH group (EIHG, n = 28), with resting blood pressure <140/90 mm Hg and maximal exercise SBP ≥210 mm Hg. Coronary artery plaque and stenosis were compared using multi-detector computed tomography.The proportion of subjects with a coronary artery calcium (CAC) score ≥10 or ≥100 units, 1 or ≥2 plaques, or plaques in ≥2 blood vessels was higher in the EIHG than in the normal blood pressure group (NBPG) (P<.05). The absolute CAC score was higher in the EIHG (42.6 ± 67.8) than in the NBPG (2.8 ± 6.0; P < .05). The CAC score distribution was higher in the EIHG (5–300 units) than in the NBPG (P < .05). The prevalence of coronary plaques and maximal luminal artery stenosis was higher in the EIHG than in the NBPG (P < .05). The EIHG showed 12 cases of stenosis, whereas the NBPG showed only 1 case (P < .05).In marathon runners, EIH was associated with increased prevalence of coronary artery plaques and could be a new risk factor for coronary artery plaque formation. Therefore, preventive measures and EIH monitoring using an exercise stress test, alongside multi-detector computed tomography, are recommended.

Lifestyle Change Diminishes a Hypertensive Response to Exercise in Type 2 Diabetes

A hypertensive response to exercise (HRE) is common in patients with type 2 diabetes and is associated with increased left ventricular (LV) mass and mortality. This study aimed to determine whether lifestyle modification would improve exercise blood pressure (BP) and reduce LV mass in patients with type 2 diabetes. One hundred and eighty-five patients with type 2 diabetes were randomized to 1 yr of lifestyle intervention (n=97, mean ± SD age=54.7 ± 11.3 yr, 51% men) or usual care (control; n=88, age=53.8 ± 8.1 yr, 61% men). Brachial BP was measured at rest and during a graded maximal exercise test at baseline and 1 yr. Patients also underwent two-dimensional echocardiography to determine LV dimensions. A subgroup of 61 patients had resting and exercise central BP estimated from radial tonometry. An HRE was defined as a maximal exercise systolic BP of ≥210 mm Hg for men and ≥190 mm Hg for women. At study entry, there were 101 patients (55%) with an HRE (n=51 controls). Compared with controls, lifestyle intervention significantly reduced the propensity to develop an HRE in those participants who did not have HRE at baseline (29.8% vs 59.5%, P=0.006). However, absolute values of exercise and resting (brachial and central) BP and LV mass were not significantly changed (all P values >0.05). There were significant (all P values <0.05) improvements in V˙O2max, body mass index, plasma glucose, insulin resistance, and HDL cholesterol after lifestyle intervention compared with control. Lifestyle intervention significantly attenuates the development of an HRE but does not reduce cardiac size after 1 yr in patients with type 2 diabetes.

KLOTHO KL‐VS Genotype is Associated with Cardiovascular Disease Risk Factors and Adaptations to Exercise Training

The KLOTHO gene has been found to affect cardiovascular disease (CVD) risk and longevity. We sought to determine if KLOTHO gene variants were associated with CVD risk factors at baseline and their responses to exercise training. Participants were sedentary, 50–75 yr old nonsmokers, BMI<37, and free of diabetes and CVD. Participants were weight and diet-stable before initial testing and were weight-stable during the 6-mo, 3 d/wk exercise program (40 min/session, 70% VO2max). VO2max was measured on a treadmill, body composition via DEXA, and plasma lipoprotein-lipids as the average of 2 fasting samples. DNA was genotyped for the KL-VS variant via RFLP with sequencing controls. At baseline G allele carriers had 7–12% higher total and LDL-C levels (P<0.05). With training TT homozygotes increased VO2max and decreased maximal exercise systolic blood pressure (SBP) more than G allele carriers (P<0.05). These data indicate that the KL-VS G risk allele adversely affects a person's total and LDL-C levels at baseline, as previously described. Furthermore, persons carrying the KLOTHO G risk allele had a smaller increase in VO2max and an increase, rather than a decrease, in maximal exercise SBP. Thus, the KLOTHO risk allele is associated with baseline CVD risk and exercise training may not reduce this risk to the same degree as in otherwise similar individuals not carrying the risk allele.

Systolic blood pressure response to exercise in type 1 diabetes families compared with healthy control individuals

Oxidative stress is increased in type 1 diabetes families. Since oxidative damage is a mediator of vascular injury and familial predisposition to hypertension increases the risk of hypertension and diabetic nephropathy, we studied blood pressure responses to exercise and cardiovascular risk factors in type 1 diabetes families. Thirty-five type 1 patients, 74 first-degree relatives, and 95 healthy individuals without established coronary heart disease underwent a cycle ergometer test. Examination included medical history, lifestyle questionnaire, body weight, blood pressure, and laboratory tests [fasting plasma glucose and insulin, haemoglobin A1c (HbA1c), plasma lipids, C-reactive protein, fibrinogen, folate, plasma thiols, and albumin excretion rate]. Diabetic patients had higher plasma glucose, HbA1c, folate, and albuminuria, while lower plasma thiols than controls; relatives differed from controls in higher plasma total cholesterol and albuminuria, lower plasma thiols. No patient presented exercised-induced angina. Diabetic patients achieved a higher maximal exercise systolic blood pressure (similar workload); systolic pressure remained high during recovery. Relatives showed higher values of systolic pressure at peak exercise (same workload). The following were associated with an abnormal blood pressure response to exercise: diastolic blood pressure and HbA1c in the control sample; disease duration and fibrinogen in the diabetic group; plasma low-density lipoprotein (LDL) cholesterol, body mass index (BMI), housework, and plasma thiols among relatives. An abnormal blood pressure response to exercise testing has been identified for the first time in asymptomatic normotensive non-diabetic relatives of type 1 diabetics, which was associated with indices of metabolic syndrome and oxidative damage. Moreover, in healthy normotensive non-diabetic control individuals (without a family history of type 1 diabetes), the systolic blood pressure response to exercise was significantly correlated with HbA1c levels.

Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function

Background Persons with high normal blood pressure (BP) or mild hypertension who also have an exaggerated BP response to exercise are at risk for worsening hypertension. The mechanisms that explain this relationship are unknown. We examined the relationships of endothelial vasodilator function and of aortic stiffness with exercise BP. Methods Subjects were 38 men and 44 women, aged 55 to 75 years, with untreated high normal BP or mild hypertension but otherwise healthy. Exercise was performed on a treadmill. Endothelial vasodilator function was assessed as brachial artery flow-mediated vasodilation (FMD) during reactive hyperemia. Aortic stiffness was measured as pulse wave velocity (PWV). Results Among men, resting systolic BP explained 34% of the variance ( P < .01) in maximal exercise systolic BP and FMD explained an additional 11% ( P < .01); resting systolic BP explained 23% of the variance in maximal pulse pressure (PP) ( P < .01), and FMD explained an additional 10% ( P < .01). Among women, resting systolic BP was the only independent correlate of maximal systolic BP ( R 2 = 0.12, P < .03) and FMD correlated negatively with maximal PP ( R 2 = 0.12, P < .03). Among men, FMD was the only independent correlate of the difference between resting and maximal systolic BP ( R 2 = 0.20, P < .02). The FMD was the only independent correlate of the difference between resting and maximal PP among men ( R 2 = 0.17, P < .03) and among women ( R 2 = 0.12, P < .03). The PWV did not correlate with exercise BP responses. Conclusions These results suggest that impaired endothelial vasodilator function may be a mechanism contributing to exercise hypertension and may also be one link between exaggerated exercise BP and worsening hypertension.

Relation between exercise-induced hypertension and sustained hypertension in adult patients after successful repair of aortic coarctation.

To investigate whether exercise-induced hypertension in successfully repaired adult post-coarctectomy patients is associated with hypertension on 24-h blood pressure measurement and increased left ventricular mass. One hundred and forty-four consecutive post-coarctectomy patients (mean age 31.5 years, range 17-74 years; mean age at repair 7.9 years, range 0-45 years) from three tertiary referral centres were studied using ambulatory blood pressure monitoring, treadmill exercise testing and echocardiography. Of the 144 patients, 27 (19%) were known to have sustained hypertension, based on their history, and all were on antihypertensive medication. However, 32 (27%) of the remaining 117 patients showed elevated mean daytime systolic blood pressure readings at 24-h ambulatory blood pressure monitoring (systolic blood pressure > or = 140 mmHg). Of the remaining 85 patients with normal mean daytime systolic blood pressure, 18 patients (21%) had exercise-induced hypertension (maximal exercise systolic blood pressure > 200 mmHg). Mean daytime systolic blood pressure was higher in the exercise-induced hypertensive patients compared to the normotensive patients with normal exercise blood pressure (134 +/- 5 versus 129 +/- 7 mmHg, P = 0.008). By multivariate analysis, both maximal exercise systolic blood pressure (P = 0.007) and resting systolic blood pressure (P < 0.0001) were independently associated with mean daytime systolic blood pressure. Maximal exercise systolic blood pressure had no independent predictive value for left ventricular mass (P = 0.132). In adult post-coarctectomy patients, maximal exercise systolic blood pressure is independently associated with mean daytime systolic blood pressure at ambulatory blood pressure monitoring. In this study no independent predictive value of maximal exercise systolic blood pressure for left ventricular mass could be demonstrated.

IS INAPPROPRIATE HYPERTENSIVE RESPONSE TO EXERCISE TEST USEFUL TO SCREEN FOR HYPERTENSION IN COPD PATIENTS?

We have previously shown that the increase in systolic blood pressure (SBP) during exercise test is much steeper in patients with chronic obstructive pulmonary disease (COPD) compared to healthy individuals matched for age. Inappropriate hypertensive response to maximal exercise (≥ 220/100 mmHg) has been associated with future development of hypertension. In the settings of a rehabilitation respiratory exercise program evaluation, exercise physiologist are often confronted with inappropriate high blood pressure (BP) response during exercise testing. PURPOSE We sought to evaluate if inappropriate hypertensive response to maximal exercise test is a reliable parameter as a screening tool for hypertension compared to office and 24-hr ambulatory BP. METHODS Twenty-three COPD patients (age: 65±7 years [mean±SD], FEVI: 40±15% predicted) performed a peak ergocycle exercise test and a 24-hr ambulatory BP monitoring. Resting BP was measured after a 15-minute resting period in supine position and maximal exercise BP was measured at the end of the peak exercise test. RESULTS Mean resting, exercise and 24-hr BP was respectively 145/73±16/11 mmHg, 231/102±24/17 mmHg and 129/75±10/8 mmHg. Sixty-one percent and 30% of patients with inappropriate hypertensive response to maximal exercise showed high BP on resting and 24-hr respectively. The association between exercise SBP and resting SBP was the following; r = 0.65, p < 0.01 but there is no relationship between exercise SBP and 24-hr SBP monitoring (r = 0.28, p = 0.19). CONCLUSION Thus, maximal exercise SBP may be a reliable index to predict office hypertension but not 24-hr high BP in patients with COPD. Supported in part by Le Fond de Recherche en Santé du Québec.

Supine and exercise systolic blood pressure predict cardiovascular death in middle-aged men.

The outcome of 1999 apparently healthy men, aged 40-59 years, initially investigated in the period 1972-1975, has previously been ascertained at 7 and 16 year follow-ups. This has now been repeated after 21 years, to determine whether seated systolic blood pressure (BP) during a bicycle ergometer exercise test adds prognostic information on cardiovascular (CV) mortality beyond that of systolic BP measured after 5 min of supine rest. After 21 years, 41 979 years of observation, 470 patients had died, 255 from CV causes. Supine systolic BP [2 SD increase: relative risk (RR) 1.6, 95% confidence interval (CI) 1.3-2.0, P < 0.0001], 6 min exercise systolic BP (2 SD increase: RR 1.6, 95% CI 1.3-2.0, P < 0.0001) on the starting workload of 600 kpm/min (approximately 100 W, 5880 J/min) and maximal systolic BP (2 SD increase: RR 1.5, 95% CI 1.2-1.9, P = 0.0005) during work were all related to CV mortality when adjusting for a large number of variables measured in the present study including age, exercise capacity, heart rates, smoking habits, glucose tolerance and serum cholesterol. When including other systolic BPs in the continuous multivariate analysis, supine systolic BP (2 SD increase: RR 1.4, 95% CI 1.04-1.9, P = 0.029) and 6 min systolic BP at 600 kpm/min (2 SD increase: RR 1.4, 95% CI 1.06-1.9, P = 0.017) were independent predictors of CV death but not maximal systolic BP during exercise (2 SD increase: RR 1.0, 95% CI 0.7-1.2, P = 0.95). These results are different from the mortality data at 16 years, when the independent predictive effect of supine systolic BP was cancelled out by 6 min exercise systolic BP at 600 kpm/min. Twenty-one years of follow-up of 1999 apparently healthy men disclose independently predictive information on CV death, of both supine systolic BP and 6 min exercise systolic BP taken at an early moderate workload. The influence of maximal exercise systolic BP on CV death is however cancelled out by the two other systolic BPs.

Maximal exercise systolic pressure, exercise training, and mortality in myocardial infarction patients

The relation of maximal exercise systolic pressure to physical conditioning and to mortality was determined in 641 men with ≥1 myocardial infarctions. Each performed a standardized multistage exercise test before randomized assignment either to an exercise group or a control group and at scheduled periodic intervals over 3 years. This study compares 123 men with maximal exercise systolic pressures (MESP) of ≤140 mm Hg with 518 men whose maximal exercise systolic pressure was ≥140 mm Hg. At baseline, the 2 groups were comparable for age, entry time since the occurrence of the qualifying cardiac event, and reported use of antihypertensive medications. Men with low MESP used more β blockers, had lower systolic pressure measurements at rest and by definition at maximal exercise, and lower work capacity than men with higher levels of MESP. Men with low MESP experienced: (1) no reduction in mortality with exercise conditioning (p <0.86), and (2) a significantly higher mortality rate over 3 years (p <0.003) compared with men with higher levels of MESP. The relation of a low MESP to mortality persisted: (1) whether MESP or work capacity increased from the baseline exercise test to the last performed exercise test, and (2) whether it was measured at low (<6 METs) or high (≥6 METs) levels of work capacity. We conclude that low maximal exercise systolic blood pressure is a predictor of mortality and is associated with an ineffective training response in men with myocardial infarction.

Improvement in exercise tolerance and immediate beta-adrenergic blockade with intranasal propranolol in patients with angina pectoris

A new intranasal spray formulation of propranolol was developed to provide β-adrenergic blocking medication on an immediate basis to patients with angina pectoris. The effects of this spray or placebo were assessed in 16 patients with effort-induced angina in a blinded, randomized, crossover design study that compared placebo with intranasal propranolol spray (5 mg/puff) 15 minutes before exercise on a treadmill (Bruce protocol). One week later, each patient, acting as his/ her own control, received the alternative treatment and repeated exercise. Mean plasma propranolol level with active therapy was 20 ng/ml. Patients with active spray demonstrated a significant increase in total exercise time than patients taking placebo (530 ± 197 vs 460 ± 177 seconds, p = 0.05), an increase in the time to 1 mm ST-segment depression on the electrocardiogram (384 ± 202 vs 327 ± 144 seconds, p <0.05), and an increase in time to onset of angina (452 ± 149 vs 363 ± 175 seconds, p = 0.0005). There was a blunting of maximal exercise heart rate with active therapy compared with placebo (120 ± 13 vs 133 ± 17 beats/min, p <0.01), blunting of maximal exercise systolic blood pressure (185 ± 22 vs 194 ± 21 mm Hg, p < 0.05), and blunting of peak double product (p < 0.0005), with more modest effects on resting heart rate. Propranolol spray is an effective approach for providing immediate β blockade and improving exercise tolerance in patients with angina pectoris.

Impact of left ventricular hypertrophy on blood pressure responses to exercise

It is claimed that exaggerated blood pressure (BP) responses to exercise are predictive of future hypertension and may also be indicative of left ventricular (LV) hypertrophy. The relation between LV hypertrophy and maximal exercise BP was examined in 35 normal male volunteers and 65 untreated hypertensive male patients. Multiple stepwise regression analysis revealed that preexercise systolic BP was the major determinant of maximal exercise systolic BP (r = 0.52; p ≤ 0.0001), indicating that higher baseline BP predicted higher exercise BP. However, hypertensive patients with LV hypertrophy had the smallest increases in systolic BP with exercise. Accordingly, there was an inverse relation between LV muscle mass and systolic BP responses to exercise in these patients (r = −0.34; p = 0.005). When compared with normotensive subjects, hypertensive patients had lower measures of maximal oxygen uptake and exercise heart rates (p = 0.01). This may indicate lower cardiac performance at maximal exercise and explain the reduced capacity of hypertensive patients with LV hypertrophy to increase systolic BP with exercise. Neither baseline nor exercise BPs correlated with LV mass; instead, the model of regression analysis indicated that body weight was the principal determinant of LV mass. Contrary to previous reports, exaggerated exercise BPs were not associated with LV hypertrophy in hypertensive or normotensive patients.

Childhood predictors of future blood pressure.

Blood pressure in infants and children is much lower than that in adults. It is suspected that children whose blood pressures are greatest for their age or body size may be destined for future hypertension. However, it is apparent that some children with lower blood pressures are also destined for hypertension as adults. Children with a family history of hypertension demonstrate greater blood pressure and heart rate responses to mental challenge. These responses are enhanced when a high salt diet is consumed. Increased maximal exercise systolic blood pressure and increased left ventricular wall mass in childhood add significantly to the prediction of future high blood pressure. In addition, the acquisition of excess weight for height from childhood to young adult life adds to the prediction of future blood pressure elevations. Both children and adults who are obese have significantly higher blood pressures than those who are lean. Approximately 34% of the variability in body mass index is explained by genotype differences at a single recessive locus, 41% by genotype differences at polygenic loci, and 25% by nongenetic factors. Thus, the genetic influence of obesity may be an important factor responsible for elevated blood pressure in both children and adults.

Is left ventricular mass in apparently healthy, normotensive men correlated to maximal blood pressure during exercise?

In 95 apparently healthy normotensive men aged 21-69 (mean 44) years with supine blood pressure (BP) less than 150/90 mmHg when less than 50 years, and less than 160/95 when greater than or equal to 50 years of age, left ventricular mass (LVM) was measured by M-mode echocardiography and related to maximal BP during a symptom-limited ergometer bicycle test. Mean LVM was 195 (+/- 43) g and LVM index (I) 101 (+/- 20) g m-2 body surface area (BSA). The subjects were subdivided into two groups: Group 1 = 28 subjects (29%) with LVM greater than or equal to 220 g, and Group 2 = 67 subjects (71%) with LVM less than 220 g. Group 1 had a slightly larger BSA (P less than 0.05), weight (P less than 0.05) and resting systolic BP (P less than 0.05). A higher prevalence of smokers (P less than 0.01) and serum cholesterol levels (P less than 0.05) were also noted among Group 1 subjects, who had a higher maximal systolic BP during exercise (P less than 0.0001). Using linear regression analysis, significant positive correlations were observed between LVM and systolic BP at rest (r = 0.20, P less than 0.05), and maximal exercise systolic BP (r = 0.32, P less than 0.001). When correcting for differences in age, weight, body surface area, physical performance, smoking and hours of exercise per week, multiple regression analysis revealed a significant between LVM and maximal systolic BP (t = 2.38, P = 0.020, Partial F = 5.64).(ABSTRACT TRUNCATED AT 250 WORDS)

Utility of Exercise Testing to Assess Aortic Recoarctation.

Because it is not known how often and how uniformly exercise testing is used to "unmask" recurrent or persistent coarctation of the aorta, this study was designed to determine (a) the frequency with which exercise testing is used by the clinician to evaluate patients after coarctation repair, and (b) the hemodynamic measures obtained with exercise that are considered to be indicative of significant persistent or recurrent coarctation. Questionnaires were sent to 80 randomly selected pediatric cardiologists; 49 were returned completed. About half of the respondents performed exercise testing (ET) on all of their patients after coarctation repair and 75 % tested at least half. Those who supervised an exercise laboratory used ET for a significantly greater number of their patients. In descending order, rest arm-leg gradient (ALG), maximal exercise systolic blood pressure (MXBP), and postexercise ALG were considered the most important indicators of significant recoarctation. The majority of respondents made decisions based on data from the ET that were consistent with published guidelines.

Correlates of resting and maximal exercise systolic blood pressure after repair of coarctation of the aorta: A multivariable analysis

Repair of coarctation of the aorta may not prevent the subsequent development of elevated systemic blood pressure at rest or with exercise. The correlates of late postoperative resting systolic blood pressure and maximal exercise systolic blood pressure levels were investigated in a retrospective study of 42 patients who had graded exercise tests after correction of coarctation of the aorta. The independent variables studied included height, weight, body surface area, age at surgery, age at exercise testing, the time interval between surgery and exercise testing, the highest systolic blood pressure prior to surgery, gradient across the coarctation at preoperative catheterization, and the residual postoperative gradient across the coarctation. The same combination of independent variables provided the best regression model for explanation of the variance of both postoperative resting and maximal exercise systolic blood pressure. The models included height, highest preoperative systolic blood pressure, and residual gradient. None of the other variables added significant explanatory ability to either model. These findings suggest that the preoperative level of systolic blood pressure may be the best determinant of timing the corrective surgery. It may be possible to defer the operation, as long as blood pressure remains normal, until an age when repair is less likely to result in recurrent coarctation.

Increased left ventricular emptying at maximal exercise after reduction in afterload.

Twelve healthy men were studied by M mode echocardiography during exercise to investigate the effect of afterload reduction on left ventricular function at maximal exertion. They performed two maximal exercise bicycle tests 4 hr apart while in the semisupine position and were given 20 mg nifedipine sublingually 30 min before the second test. During the first test end-systolic dimension decreased (p less than .01) and fractional shortening increased from rest to peak exercise (p less than .01), while end-diastolic dimension did not change significantly. At maximal exercise systolic blood pressure was lower after nifedipine than in the preceding control test (202 +/- 10 [mean +/- SD] vs 212 +/- 14 mm Hg; p less than .01), while heart rate was not significantly changed (168 +/- 15 vs 162 +/- 13 beats/min). End-systolic dimension was lower (25.6 +/- 3.3 vs 28.8 +/- 4.2 mm; p less than .01) and fractional shortening higher (50.7 +/- 6.0% vs 45.3 +/- 7.0%; p less than .01) while end-diastolic dimension was unchanged (52.3 +/- 1.9 vs 52.4 +/- 2.6 mm). Our data indicate increased left ventricular emptying at maximal exercise after nifedipine, most probably due to reduction in afterload.