Exercise Systolic Blood Pressure Research Articles

Analysis of influencing factors of exercise systolic blood pressure response in nonalcoholic fatty liver disease aged 40–60 years

ABSTRACT Objectives This study investigated the influencing factors of exercise systolic blood pressure response (ESBPR) by cardiopulmonary exercise test (CPX) in nonalcoholic fatty liver disease (NAFLD) in people aged 40–60 years. Methods A total of 603 adults were enrolled in this study. The inclusion criteria of this cross-sectional study were adults who underwent health checks and CPX. Results There were significant differences in body mass Index (BMI) (26.80 ± 2.64 VS 23.31 ± 2.41, p < 0.001) kg/m2, fasting blood glucose (FPG) (5.56 ± 0.94 VS 5.13 ± 0.55, p < 0.001) mmol/L, alanine aminotransferase (ALT), aspartate transaminase (AST), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C) (1.13 ± 0.22 VS 1.43 ± 0.33, p < 0.001) mmol/L, low-density lipoprotein-cholesterol (LDL-C) (3.21 ± 0.79 VS 2.99 ± 0.68, p = 0.001) mmol/L, resting systolic blood pressure (SBP) (123.53 ± 14.73 VS 118.79 ± 14.79, p < 0.001) mmHg, resting diastolic blood pressure (DBP) (80.29 ± 9.62 VS 75.27 ± 10.41, p < 0.001) mmHg, peak SBP (184.01 ± 23.50 VS 172.81 ± 24.95, p < 0.001) mmHg, peak DBP (87.47 ± 10.50 VS 84.01 ± 11.46, p = 0.001) mmHg, oxygen pulse (VO2/HR) (0.88 ± 0.15 VS 0.92 ± 0.16, p = 0.004) ml/beat, exercise maximum heart rate, carbon dioxide Ventilation equivalent (VE/VCO2) (25.84 ± 4.43 VS 25.12 ± 3.58, p = 0.038), peak oxygen uptake (VO2 peak) (1.78 ± 0.45 VS 1.56 ± 0.46, p < 0.001) mL/min between the NAFLD and control groups. VE/VCO2 (OR = 0.822, p = 0.036) and oxygen uptake/work rate (VO2/WR) (OR = 0.517, p = 0.021) mL/min/watt were associated with a lower risk of ESBPR in NAFLD subjects. Resting SBP was associated with a higher risk of ESBPR in NAFLD patients (OR = 1.059, p = 0.003) and overweight NAFLD subjects (OR = 1.075, p = 0.002). ESBPR (OR = 1.268, p = 0.045), skeletal-muscle mass (OR = 1.305, p < 0.001), and SMI (OR = 1.315, p < 0.001) were linked to an elevated risk of NAFLD in individuals. Conclusion Our findings indicate that ESBPR is associated with an increased risk of NAFLD in individuals aged 40–60 years. Furthermore, in NAFLD subjects, VE/VCO2 and VO2/WR were found to be correlated with a decreased risk of ESBPR, whereas resting SBP was linked to an elevated risk of ESBPR. This will provide a research basis for the NAFLD subjects who have ESBPR at risk of adverse events during exercise.

Test-retest reliability of exercise blood pressure and the workload-indexed systolic blood pressure slope in healthy males and females.

The reliability of blood pressure (BP) measured during submaximal and maximal exercise, and confounding effects of biological sex, remain to be fully established but have implications for using exercise BP as a cardiovascular risk factor. We hypothesize that exercise BP test-retest reliability will not differ between sexes but will be higher during submaximal compared to maximal exercise. Eighty-four participants (22 ± 5 yr; 36 females) completed two maximal treadmill tests (modified Bruce protocol) separated by ≥2 days. Exercise BP was measured every 90 s using automated auscultation (Tango M2 monitor). Breath-by-breath oxygen uptake was analyzed. Test-retest reliability was assessed using two-way, mixed-effects, consistency, single-rater intraclass correlation coefficient (ICC) analysis on the total group and separated by sex at submaximal and maximal exercise. Systolic BP during submaximal (ICC = 0.65 [0.49-0.76], P < 0.01) and maximal (ICC = 0.66 [0.52-0.77], P < 0.01) exercise both displayed substantial reliability between visits. In contrast, the SBP/MET slope showed poor submaximal (ICC = 0.12 [-0.09-0.33], P = 0.13) but substantial maximal (ICC = 0.63 [0.48-0.75], P < 0.01) exercise reliability. Females showed substantial reliability in submaximal systolic BP (ICC = 0.73 [0.53-0.85], P < 0.01) and peak systolic BP (ICC = 0.74 [0.54-0.87], P < 0.01) and SBP/MET slope (ICC = 0.78 [0.60-0.88], P < 0.01); the submaximal SBP/MET slope had fair reliability (ICC = 0.28 [-0.06-0.56], P = 0.05). Males showed moderate reliability in submaximal systolic BP (ICC = 0.53 [0.26-0.72], P < 0.01) and peak systolic BP (ICC = 0.41 [0.15-0.62], P < 0.01) and SBP/MET slope (ICC = 0.48 [0.22-0.67], P < 0.01); the submaximal SBP/MET slope had poor reliability (ICC = 0.06 [-0.18-0.31], P = 0.32). Systolic BP showed similar reliability during submaximal and maximal exercise, with females demonstrating higher reliability in exercise systolic BP compared to males.NEW & NOTEWORTHY Limited work has assessed the reliability of exercise blood pressure (BP) in young healthy males and females. Our results demonstrate that systolic BP test-retest reliability did not differ between submaximal and maximal exercise. Sex-specific analysis found that females had higher reliability in exercise systolic BP than males. Despite the acceptable average reliability, exercise BP measured using automated auscultation possesses wide confidence intervals, which impact sample size requirements in future trials.

Exaggerated blood pressure response to submaximal exercise must be considered relative to fitness: strong associations with hypertensive target organ damage

Abstract Exaggerated systolic blood pressure (SBP) during submaximal exercise is associated with increased cardiovascular (CV) risk. However, findings are mixed and new evidence indicates that cardiorespiratory fitness should be considered for proper clinical interpretation of exercise SBP responses. This study aimed to determine the relationship between SBP response to submaximal effort corrected for fitness and abnormalities of cardiac structure and function. Methods Each of 231 participants (age 54±12 years; 53% females) with controlled clinic BP, no evidence for ischemic heart disease, valvular heart disease or heart failure underwent cardiopulmonary exercise testing (Bruce protocol), resting and exercise echocardiography and 24h ABPM. Submaximal exercise SBP (measured at the 2nd stage of Bruce protocol) was corrected for two fitness variables: 1) peak VO2 and 2) maximal workload in METs (SBP/peakVO2 and SBP/METs). Results There were no, or weak, associations with exercise SBP and target organ damage. However, there was a progressive deterioration of cardiac function and structure parameters across the exercise SBP tertiles corrected for fitness (Table 1). Both SBP/peakVO2 and SBP/METs significantly correlated with left ventricular (LV) mass, LV diastolic and systolic, and left atrial parameters (Table 2). ROC analysis revealed good performance of corrected SBP response to submaximal exercise in detection of LV hypertrophy and diastolic dysfunction (AUC 0.792 and 0.808, and 0.771 and 0.802 for SBP/peakVO2 and SBP/METs, respectively; Figure). Conclusions Fitness-corrected SBP responses to submaximal exercise can identify more profound target organ damage with respect to cardiac function and structure even among patients with controlled clinic BP. Exaggerated BP response to exercise must be considered relative to fitness for proper clinical interpretation of BP responses to exercise testing.Figure

A flattening systolic blood pressure response at the end of ramp exercise testing is not associated with all-cause mortality

Abstract Purpose Systolic blood pressure (SBP) is expected to rise linearly during ramp exercise, but sometimes plateaus before the end of exercise. We aimed to examine the predictive value of a plateauing SBP response at the end of a cycle exercise test. Methods We analyzed 9,001 consecutive patients aged ≥18 years with maximal cycle ergometer ramp tests, after excluding subjects with valvulopathy, pacemaker, arrhythmia during the test, or body mass index (BMI) &amp;gt;40kg/m², as well as tests with resting SBP &amp;lt;80mmHg or &amp;gt;200mmHg, exercise SBP &amp;lt;100 mmHg, &amp;lt;2 SBP measurements during the second half of the test or a test duration &amp;lt;4 minutes. The data were cross-linked with nationwide registries for mortality and in- and outpatient hospital diagnoses. The difference in SBP between the two last SBP measurements was standardized to the difference in Watts between the same time points, categorized as i) an SBP decrease (drop), ii) an SBP increase of &amp;lt;2.5 mmHg per 10 Watts increase (flat), iii) an SBP increase of 2.5-15 mmHg/10 Watts (intermediate), and iv) an SBP increase &amp;gt;15 mmHg/10 Watts representing the 97.5th percentile (steep). Hazards ratios (HR, [95% confidence interval, CI]) for all-cause mortality were calculated, stratified for exercise capacity (peak Watt % of predicted) with the intermediate SBP response as reference. Adjustments were made for age, sex, BMI, resting SBP, baseline diagnosis of ischemic heart disease, heart failure, chronic obstructive pulmonary disease, and the use of beta-blockers or anti-hypertensive medication. Results Decreasing, flat, intermediate, and steep SBP responses at the end of exercise were present in 1.1%, 25.6%, 70.8% and 2.5% of patients respectively (Table 1). During median follow-up 8.6 years (interquartile range 5.9–11.6 years) there were 844 deaths. When compared to an intermediate SBP response, a flat SBP response was not associated with all-cause mortality in any of the exercise capacity strata: lowest tertile of Wmax%pred unadjusted HR 0.88 (95% CI 0.69–1.11), middle tertile HR 0.91 (95% CI 0.66–1.24), and highest tertile HR 0.95 (95% CI 0.64–1.41), with HRs remaining non-significant after adjustment for covariates (Table 2). Conclusion In patients referred for exercise testing, a flattening SBP response at the end of exercise was not associated with increased all-cause mortality risk compared to an intermediate SBP response, consistent across the different exercise capacity strata.

Blood pressure response to exercise in endurance athletes with and without paroxysmal atrial fibrillation.

Abstract Background Atrial fibrillation (AF) is more prevalent among endurance-trained athletes when compared to non-athletes. The underlying pathophysiology and mechanisms for this phenomenon remain unknown but repeated exposure to an exaggerated blood pressure (BP) response during exercise may contribute to the development of AF in this population. Purpose We aimed to assess whether endurance athletes with AF have a higher maximal systolic BP (SBP) or a higher BP relative to exercise intensity compared to endurance athletes without AF. Methods Endurance athletes with paroxysmal AF (n=66, 96% male) from the ProAFHeart, NEXAF Detraining and Master@Heart studies were matched for age and sex to endurance athletes without AF (n=66, 96% male). Participants with a history of hypertension were excluded. All athletes underwent a maximal graded cardiopulmonary exercise test on a cycle ergometer to assess exercise BP using an automated auscultatory BP machine, maximal oxygen uptake (VO2peak) and peak workload. All athletes were in sinus rhythm at the time of testing and BP was measured pre-exercise seated on the bike and every 2 min throughout the test. Exercise BP measurements included the maximum exercise SBP (SBPmax) and the slopes of the relationships between SBP, diastolic BP (DBP) and workload (W) as determined from linear regression analysis (SBP/W-slope and DBP/W-slope, respectively). The resting SBP and DBP were measured in the supine position after 10min of rest. Independent T-test (parametric data) or the Mann-Whitney U-test (non-parametric data) assessed for the differences between the two groups. Results The 66 athletes with AF were of similar age and sex as the 66 athletes without AF, median age (55 [IQR 45, 61] vs 54 [IQR 44, 62] years, p=0.839), 4% female. There was no difference in (mean±SD) VO2peak (46 ±9 vs 49±10 mL/kg/min, p=0.114) and peak workload (365±67 vs 385±83 W, p=0.136), nor resting SBP (131±13 vs 128±13 mmHg, p=0.169) and resting DBP (76±9 vs 75±11 mmHg, p=0.465) between athletes with and without AF respectively (Table 1). Athletes with AF showed no significant difference to athletes without AF for exercise BP responses (Figure 1) including SBPmax (222±22 vs 219±28 mmHg, p=0.479), SBP/W-slope (0.22±0.07 vs 0.24±0.08 mmHg/W, p=0.310) and median DBP/W-slope (-0.01 [IQR -0.02, 0.01] vs -0.01 [IQR -0.03, 0.02] mmHg/W, p=0.703). Conclusion When comparing endurance athletes with and without paroxysmal AF, there were no differences in the maximal BP attained during exercise or in their BP response indexed to external workload (SBP/W-slope) suggesting that exercise-induced hypertension does not explain the athletic predisposition to AF.

Correlation of exercise blood pressure levels with concomitant cardiovascular disease.

Hypertension is a fatal but preventable risk factor for cardiovascular disease and an important cause of death from cardiovascular disease. Exercise training has a definite clinical effect on blood pressure control. However, inappropriate exercise is ineffective and may also cause disease. The aim of this study was to evaluate the possible factors influencing blood pressure level in an exercise treadmill test and its relationship with accompanying clinical diseases. Five hundred sixty-four patients who underwent exercise treadmill test were selected and divided into the abnormal exercise blood pressure group (n = 156, age 60.46 ± 9.2 years) and normal exercise blood pressure group (n = 408, age 56.57 ± 8.8 years) according to whether the peak exercise systolic blood pressure was more than or equal to 180 mm Hg. General clinical data and associated clinical diseases were collected from both groups. The prevalence of hypertension and coronary atherosclerotic heart disease in the abnormal exercise blood pressure group was significantly higher than that in the normal exercise blood pressure group (all P < .05). At the same time, the smoking rate and glycohemoglobin level of the patients with abnormal exercise blood pressure were significantly increased (all P < .05), but there was no statistically significant difference in age, sex, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and other indicators between the 2 groups (all P > .05). Patients with abnormal exercise blood pressure response have a higher prevalence of hypertension and coronary heart disease. Exercise blood pressure level may be an important factor affecting patients' cardiovascular prognosis.

P135 FITNESS INFLUENCES THE RELATIONSHIP BETWEEN EXERCISE BLOOD PRESSURE AND LEFT VENTRICULAR STRUCTURE: EVIDENCE FROM THE EXERCISE STRESS TEST COLLABORATION (EXERTION) STUDY

Background. A hypertensive response to exercise is associated with left ventricular (LV) remodelling, a principal sign of hypertensive heart disease. Fitness may modify this relationship, making clinical interpretation of peak exercise systolic blood pressure (SBP) challenging. This study examines the influence of fitness on the relationship between peak exercise SBP and LV structure. Methods. Cardiovascular structure and function (LV mass index (LVMI), LV relative wall thickness (RWT), cardiac output (CO) and total peripheral resistance (TPR)) were assessed at rest by echocardiography on 4,309 individuals (aged 58.6±12.7 years,52.0% male). SBP was measured at peak treadmill exercise, and fitness (exercise duration (minutes)) was grouped into thirds. Multiple regression analysis was conducted with fitness as an interaction term with peak exercise SBP, adjusted for age, sex, pre-exercise SBP, and cardiovascular disease (CVD) history. Results. Peak exercise SBP was similar across low (180±26.5mmHg), moderate (181±26.3mmHg) and high (182±24.5mmHg) fitness groups. Fitness modified the relationship between exercise SBP and LVMI; each 5mmHg increase in exercise SBP was associated with LVMI in moderate [0.27(0.10–0.43) and high [0.25(0.06–0.43)] fitness groups, which was not observed among those with low fitness [-0.05(-0.22–0.12)]. RWT increased with higher peak exercise SBP at all fitness levels (all p&lt;0.001), with higher values among those with low fitness. Prevalence of LV concentric remodelling was highest in those with low fitness (29.9%) and lowest in those with high fitness (10.8%). A lower CO and higher TPR were observed in the low fitness group (7.5±2.5L/min and 14.3±5.1mmHg min/L) compared to those with high fitness (10.9±3.1L/min and 9.2±2.09mmHg min/L). Conclusion. Whilst a small effect, fitness modified the peak exercise SBP-LV structure relationship, such that for similar peak exercise SBP, those with low fitness exhibit a more adverse LV remodelling, with lower CO and higher TPR, compared to those with higher fitness. Considering fitness when interpreting SBP and cardiac imaging results from exercise stress testing may be relevant in identifying CVD risk and optimal patient management.

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.

Plasma Proteomics of Exercise Blood Pressure and Incident Hypertension

Blood pressure response during acute exercise (exercise blood pressure [EBP]) is associated with the future risk of hypertension and cardiovascular disease (CVD). Biochemical characterization of EBP could inform disease biology and identify novel biomarkers of future hypertension. To identify protein markers associated with EBP and test their association with incident hypertension. This study assayed 4977 plasma proteins in 681 healthy participants (from 763 assessed) of the Health, Risk Factors, Exercise Training and Genetics (HERITAGE; data collection from January 1993 to December 1997 and plasma proteomics from January 2019 to January 2020) Family Study at rest who underwent 2 cardiopulmonary exercise tests. Individuals were free of CVD at the time of recruitment. Individuals with resting SBP ≥160 mm Hg or DBP ≥100 mm Hg or taking antihypertensive drug therapy were excluded from the study. The association between resting plasma protein levels to both resting BP and EBP was evaluated. Proteins associated with EBP were analyzed for their association with incident hypertension in the Framingham Heart Study (FHS; n = 1177) and validated in the Jackson Heart Study (JHS; n = 772) and Multi-Ethnic Study of Atherosclerosis (MESA; n = 1367). Proteins associated with incident hypertension were tested for putative causal links in approximately 700 000 individuals using cis-protein quantitative loci mendelian randomization (cis-MR). Data were analyzed from January 2023 to January 2024. Plasma proteins. EBP was defined as the BP response during a fixed workload (50 W) on a cycle ergometer. Hypertension was defined as BP ≥140/90 mm Hg or taking antihypertensive medication. Among the 681 participants in the HERITAGE Family Study, the mean (SD) age was 34 (13) years; 366 participants (54%) were female; 238 (35%) were self-reported Black and 443 (65%) were self-reported White. Proteomic profiling of EBP revealed 34 proteins that would not have otherwise been identified through profiling of resting BP alone. Transforming growth factor β receptor 3 (TGFBR3) and prostaglandin D2 synthase (PTGDS) had the strongest association with exercise systolic BP (SBP) and diastolic BP (DBP), respectively (TGFBR3: exercise SBP, β estimate, -3.39; 95% CI, -4.79 to -2.00; P = 2.33 × 10-6; PTGDS: exercise DBP β estimate, -2.50; 95% CI, -3.29 to -1.70; P = 1.18 × 10-9). In fully adjusted models, TGFBR3 was inversely associated with incident hypertension in FHS, JHS, and MESA (hazard ratio [HR]: FHS, 0.86; 95% CI, 0.75-0.97; P = .01; JHS, 0.87; 95% CI, 0.77-0.97; P = .02; MESA, 0.84; 95% CI, 0.71-0.98; P = .03; pooled cohort, 0.86; 95% CI, 0.79-0.92; P = 6 × 10-5). Using cis-MR, genetically predicted levels of TGFBR3 were associated with SBP, hypertension, and CVD events (SBP: β, -0.38; 95% CI, -0.64 to -0.11; P = .006; hypertension: odds ratio [OR], 0.99; 95% CI, 0.98-0.99; P < .001; heart failure with hypertension: OR, 0.86; 95% CI, 0.77-0.97; P = .01; CVD: OR, 0.84; 95% CI, 0.77-0.92; P = 8 × 10-5; cerebrovascular events: OR, 0.77; 95% CI, 0.70-0.85; P = 5 × 10-7). Plasma proteomic profiling of EBP identified a novel protein, TGFBR3, which may protect against elevated BP and long-term CVD outcomes.

Exercise systolic blood pressures are unaffected by time of day in healthy young adults.

Blood pressure (BP) assessment during exercise testing has the capacity to identify exaggerated exercise BP (EEBP). BP has a circadian rhythm; therefore, exercise BPs may change throughout the day complicating EEBP identification. The purpose of this study was to determine the effect of time of day on exercise BP in healthy young adults. Thirty-one participants [48% female; 23(4) years] completed a modified Bruce treadmill protocol in the morning (M), afternoon (A), and evening (E). Submaximal (stage 4) and peak (highest value) systolic BP (SBP) were determined and ΔSBP was calculated (peak SBP-pre-exercise SBP). Repeated-measures tests were used to compare SBP data. EEBP was defined as a submaximal SBP ≥ 170 mmHg. Chronotype was assessed using the Morning-Eveningness Questionnaire (MEQ) and Pearson correlations were used to determine the relationship between MEQ score and ΔSBP during all tests. Significance was set at P < 0.05. Submaximal SBP (M:159(25); A:156(16); E:162(24) mmHg; P = 0.295), peak SBP (M:177(32); A:184(25); E:185(26) mmHg; P = 0.087) and ΔSBP (M:62(29); A:67(23); 65(20) mmHg; P = 0.546) were similar across time points. Eight participants had an EEBP on at least two tests. MEQ scores were correlated with ΔSBP during the A test (r = 0.357, P = 0.049) and E test (r = 0.363, P = 0.045). In conclusion, time of day had no effect on SBP responses to exercise, but our correlational analysis suggests changes in SBP may differ between chronotypes depending on the time of day of exercise. Given the clinical value of EEBP, it is notable that 26% of our healthy young sample had EEBP.

Impact of squatting on selected cardiovascular parameters among college students

Squatting is an active posture test used in assessing baroreflex sensitivity, and the array of patients a physiotherapist handles may benefit from this test to avoid the adverse effects of exercise. Therefore, this study is designed to evaluate the effect of squatting on heart rate and blood pressure among undergraduate students. 35 males (mean age = 22.94 ± 1.846) and 40 females (mean age = 22.28 ± 2.075) participated in this experimental study. Demographic data and baseline cardiovascular parameters (blood pressure and heart rate) were taken before exercise. The exercise protocol, the squatting stress test, was done for 2 min, after which post-exercise blood pressure and heart rate were taken at one minute each. A repeated measure ANOVA and independent t-test were used to analyse the difference at the 0.05 alpha level. It was found that there was a significant difference between pre-exercise in lying and squatting post-exercise blood pressure and heart rate in the first and second minutes (p < 0.01), pre-exercise in lying and standing post-exercise blood pressure and heart rate in the first and second minutes (p < 0.01), pre-exercise in standing and standing post-exercise blood pressure and heart rate in the first and second minutes (p < 0.01), and pre-exercise in standing and squatting post-exercise blood pressure and heart rate in the first and second minutes (p < 0.01). Also, there was a significant difference in pre-exercise heart rate between lying and standing (p < 0.05) and not between the first minute and second minute post-squatting or standing exercise systolic blood pressure (p = 0.588) or diastolic blood pressure (p = 0.22–1). In conclusion, squatting trials among undergraduates revealed some statistically significant changes, especially between the cardiopulmonary parameters obtained in a standing position compared to lying and those measured after one minute. Therefore, caution should be observed when administering exercises that require changes in posture.

Does Psychological State Influence the Physiological Response to Cardiac Rehabilitation in Older Adults?

Background and Objectives: Cardiovascular diseases (CVDs) are a major global cause of death. Effective secondary prevention is crucial, involving risk factor modification and cardiac rehabilitation. However, mental factors, particularly depression, exert a significant influence on CVD outcomes by increasing cardiovascular risk and impeding treatment adherence. Therefore, the aim of this study is to assess the impact of psychological state on the effectiveness of rehabilitation in cardiac patients. Materials and Methods: Thirty-three patients referred for cardiac rehabilitation participated in a 3-week program, retrospectively categorized into two groups: those with and without depressive symptoms. The functional status of the patients was assessed using the R.A.M.P. protocol exercise test, conducted on a treadmill, during which resting and exercise heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and metabolic equivalent of task (MET) measurements were taken. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS-10) were utilized to evaluate the patients' psychological state. Stepwise regression explored the psychological factors explaining physiological parameter variance. Results: Participants without depressive symptoms exhibited significantly greater improvements in exercise HR (15.58 vs. 1.07; p = 0.02), exercise SBP (7.93 vs. -2.05; p = 0.05), and exercise METs (1.52 vs. 0.50; p = 0.006) compared to those with depressive symptoms. The following predictors were found to be significant: for exercise HR-HADS-D (r2 = 12%; p = 0.04); for exercise DBP-PSS-10 (r2 = 27%; p = 0.002); and for METs-HADS-D and age (r2 = 26%; p = 0.01). Conclusions: In conclusion, cardiac rehabilitation improved psychological and physiological parameters in both groups, with greater effectiveness seen in those without depression. Depressive symptoms predicted exercise HR, SBP, and METs, highlighting their role in worsening cardiac disease. Emphasizing psychological factors, including depression and stress, in cardiac rehabilitation can enhance effectiveness and patient outcomes.

Increased Resting and Peak Exercise Systolic Blood Pressure in Children Throughout the COVID-19 Pandemic.

The COVID-19 pandemic created significant disruptions to daily life. Lockdown effects resulted in decreased exercise capacity and increased blood pressure in adults and adolescents in the first year of the pandemic. We examined changes in exercise capacity (peak workload, ventilatory anaerobic threshold-VAT, and VO2 peak), resting BP, and peak exercise BP in children before the COVID-19 pandemic and throughout five 6-month intervals of the pandemic. 951 maximal cardiopulmonary exercise tests completed by healthy children aged ≤ 18years were analyzed retrospectively. BP was auscultated. Tests were divided into pre-pandemic and six-month intervals starting from the declaration of the pandemic (Interval 1: March 11 2020-August 2020, Interval 2: September 2020-February 2021, Interval 3: March-August 2021, Interval 4: September 2021-February 2022, Interval 5: March-August 2022). Peak workload, VAT, and VO2 peak were unchanged from pre-pandemic baseline until Interval 3, when they were significantly decreased. Exercise capacity then returned to values unchanged from baseline. Peak exercise systolic BP was significantly higher than baseline in Intervals 2, 4, and 5. Resting systolic BP was significantly higher than baseline in Interval 5. There was no significant difference in age, sex, BMI, or peak exercise heart rate between intervals. Peak exercise BP was elevated above pre-pandemic baseline when exercise capacity was unchanged. The decrease in exercise capacity subsequently resolved, but the increase in post-exercise BP remained in Intervals 4 and 5. An increase in peak exercise BP preceded a small but significant increase in resting systolic BP.

Risk of cardiocerebrovascular diseases is increased in Korean women with polycystic ovary syndrome: a nationwide cohort study

To investigate the relationship between polycystic ovary syndrome (PCOS) and risk of cardiocerebrovascular disease in Korean women. This longitudinal cohort study using data from the Korean National Health Insurance Service included the women aged 15–44 years diagnosed with PCOS between 2002 and 2019, and the controls were matched 1:3 by age group, income, and region of residence. The endpoint outcomes of this study were the occurrence of ischemic heart disease, cerebrovascular diseases, and combined cardiocerebrovascular diseases in the PCOS and control groups. A stratified Cox proportional hazards regression analysis for matched data was performed to evaluate the relative hazard of events in the PCOS group compared to that in the control group. Among a total of 549,400 participants in the cohort, 137,416 women had a diagnosis of PCOS and 412,118 women did not have it. During a median follow-up of 54 months (interquartile range, 30–78 months), the incidence rates of all cardiovascular, ischemic heart, and cerebrovascular diseases were 6.6, 4.0, and 2.9, respectively, per 1000 person-years for women with PCOS, and 4.8, 2.8, and 2.3, respectively, per 1000 person-years for healthy control women. Women with PCOS had a higher hazard ratio of 1.224 (95% confidence interval, 1.18–1.27) of the composite cardiocerebrovascular diseases than those in the controls after propensity score matching for confounding variables, including body mass index, diabetes mellitus, hypertension, dyslipidemia, physical exercise level, alcohol consumption, current smoking, systolic and diastolic blood pressures, total cholesterol, and triglyceride levels. Hazard ratio for ischemic heart and cerebrovascular diseases was higher in women with PCOS than in the control group (hazard ratio, 1.254; 95% confidence interval, 1.20–1.31 and hazard ratio, 1.201; 95% confidence interval, 1.14–1.27, respectively). PCOS is associated with an increased risk of cardiocerebrovascular diseases in Korean women irrespective of their obesity. Counselling on the management of long-term risk of cardiovascular diseases should be offered to women with PCOS in East Asian countries where PCOS is characterized by a relatively low BMI.

Exercise systolic blood pressure response during cycle ergometry is associated with future hypertension in normotensive individuals.

We aimed to investigate the association between the exercise systolic blood pressure (SBP) response and future hypertension (HTN) in normotensive individuals referred for cycle ergometry, with special regard to reference exercise SBP values and exercise capacity. In this longitudinal cohort study, data from 14 428 exercise tests were cross-linked with Swedish national registries on diagnoses and medications. We excluded individuals with a baseline diagnosis of cardiovascular disease or HTN. The peak exercise SBP (SBPpeak) was recorded and compared with the upper limit of normal (ULN) derived from SBPpeak reference equations incorporating age, sex, resting SBP, and exercise capacity. To evaluate the impact of exercise capacity, three SBP to work rate slopes (SBP/W-slopes) were calculated, relative to either supine or seated SBP at rest or to the first exercise SBP. Adjusted hazard ratios [HRadjusted (95% confidence interval, CI)] for incident HTN during follow-up, in relation to SBP response metrics, were calculated. We included 3895 normotensive individuals (49 ± 14 years, 45% females) with maximal cycle ergometer tests. During follow-up (median 7.5 years), 22% developed HTN. Higher SBPpeak and SBPpeak > ULN were associated with incident HTN [HRadjusted 1.19 (1.14-1.23) per 10 mmHg, and 1.95 (1.54-2.47), respectively]. All three SBP/W-slopes were positively associated with incident HTN, particularly the SBP/W-slope calculated as supine-to-peak SBP [HRadjusted 1.25 (1.19-1.31) per 1 mmHg/10 W]. Both SBPpeak > ULN based on reference values and high SBP/W-slopes were associated with incident HTN in normotensive individuals and should be considered in the evaluation of the cycle ergometry SBP response.

The cardiovascular response to exercise in athletes recovering from SARS-CoV-2 infection: A prospective cohort study with repeated measures over 16 weeks – AWARE IX

ABSTRACT Higher exercise heart rate (HR) and prolonged return-to-sport in athletes with SARS-CoV-2 infection are described, but the cardiovascular response to exercise during recovery is not understood. This prospective, cohort, experimental study with repeated measures evaluated the cardiovascular response to exercise over 16 weeks in athletes recovering from SARS-CoV-2 infection. Athletes (n = 82) completed 2–5 repeat assessments at regulated intervals over 16 weeks post-SARS-CoV-2 infection. Data from 287 assessments (submaximal exercise tests; Modified Bruce protocol) are included. HR (bpm), systolic blood pressure (SBP) (mmHg) and rating of perceived exertion (RPE) (Borg scale 6–20) were measured. Rates of change in HR, SBP and RPE over time are reported. Submaximal exercise HR, SBP and RPE decreased significantly over 16 weeks (p < 0.01). There was a steeper rate of decline for HR and RPE ≤30 days compared to >30 days after SARS-CoV-2 infection: HR at Stage 3: ≤30 days −0.53 (0.01); >30 days −0.06 (0.02) and Stage 5: ≤30 days −0.77 (0.12); >30 days −0.12 (0.02); RPE at Stage 3: ≤30 days −0.09 (0.02); >30 days −0.01 (0.0002) and Stage 5: ≤30 days −0.13 (0.02); >30 days −0.02 (0.004). The findings provide clinical recommendation for exercise prescription and monitoring RPE in response to exercise post-SARS-CoV-2 infection and contribute to the clinical understanding of recovery which can help manage athlete expectations.

Former SARS-CoV-2-Infection is related to decreased peak VO2 and exercise hyperten-sion in athletes

Abstract Background The COVID-19 pandemic dramatically changed lifestyle worldwide, including sport activities. Although most competitive athletes have an asymptomatic or mildly symptomatic SARS-CoV-2-infection course and are a low-risk population to develop cardiac and other complications after SARS-CoV-2-infection, a post-COVID-19 screening strategy primarily based on symptoms should detect cardiac involvement and other complications from SARS-CoV-2-infection and should enable save and early return-to-sport. However, incidence, complications and performance consequences of COVID-19-infection in athletes are not fully understood. Purpose Thus, the primary aim of the present study was to identify differences in athletes with former COVID-19-infections in comparison to those athletes without COVID-19-infection presenting for their preparticipation screening examination. Methods Competitive athletes of any age, who presented for preparticipation screening 04/2020-10/2021 were included in this study and stratified for former COVID-19-infection. Athletes with and without former COVID-19-infection were compared. Exercise hypertension was defined on the basis of the systolic blood pressure (BP)/MET slope-method: The Δ regarding systolic BP was calculated as maximum systolic BP during exercise–systolic BP at rest and was indexed by the increase in MET from rest (Δ regarding MET was calculated as peak MET – 1) to obtain the systolic BP/MET slope. In accordance with previous studies, a cut-off value &amp;gt; 6.2 mmHg/MET was used to define an exercise hypertension. Results Overall, 1200 athletes (mean age 21.9±11.6years; 34.3% females) were included in this study 04/2020-10/2021. Among these, 158 (13.1%) athletes had former COVID-19-infection. Athletes with former COVID-19-infection were older (23.4±7.1 vs. 21.7±12.1years, P&amp;lt;0.001) and more often of male sex (87.7% vs. 64.0%, P&amp;lt;0.001). While systolic/diastolic BP at rest was comparable between both groups, maximum systolic (190.0 [170.0/210.0] vs. 180.0 [160.0/205.0] mmHg, P=0.007) and diastolic BP (70.0 [65.0/75.0] vs. 70.0 [60.0/75.0] mmHg, P=0.012) during exercise-test and frequency of exercise hypertension (54.2% vs. 37.8%, P&amp;lt;0.001) were both higher in athletes with COVID-19-infection. While former COVID-19-infection was not independently associated with higher BP values at rest and maximum BP values during exercise, former COVID-19-infection was related with exercise hypertension (OR 2.13 [95%CI 1.39–3.28], P&amp;lt;0.001). VO2-peak value during exercise was lower in athletes with former COVID-19-infection compared to those without COVID-19-infection (43.4 [38.3/48.0] vs. 45.3 [39.1/50.6] ml/min/kg, P=0.010). SARS-CoV-2-Infection affected VO2 peak during exercise negatively (OR 0.94 [95%CI 0.91–0.97], P&amp;lt;0.0019) independent of age, sex and body-mass-index. Conclusions Former COVID-19-infection in athletes was accompanied by higher frequency of exercise hypertension and reduced peak VO2 during exercise testing.

The effect of 12 weeks supervised exercise-based cardiac rehabilitation on resting and exercise blood pressure in males and females

Abstract Background Exercise is key in the prevention and management of hypertension. It remains unclear to what extent sex differences exist with regard to changes in blood pressure (BP) in patients following an exercise-based cardiac rehabilitation (CR) program. Purpose To investigate the effect of a 12 week supervised exercise-based CR program on resting BP (BPrest), peak exercise BP (BPmax) and systolic BP (SBP)/metabolic equivalents (MET)-slope and compare sex differences. Methods Of 2963 patients referred for CR at a singular test centre in Belgium during the years 2010-2019, those with missing BP data or with a submaximal (RER&amp;lt;1.1) cardiopulmonary exercise test (CPET) were excluded. Reasons for referral included post myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery and valve surgery. Patients underwent a bicycle CPET with BP measured at rest seated on the bike (BPrest) and throughout the test using an automated auscultatory BP machine at baseline and after 12 weeks of CR. BPrest, BPmax, peak oxygen uptake (VO2peak), peak workload (Wattpeak), resting heart rate (HRrest), maximal HR (HRmax) and the SBP/MET-slope were recorded from each test. CR incorporated 3 sessions of supervised aerobic and resistance exercise per week. Results A final sample of 2500 patients (20.4% females) were included for analysis with similar age (62±11 for males vs 61±11years for females, P=0.142). More males were on an ACE-inhibitor (55 vs 46% females, P&amp;lt;0.001) with a comparable prevalence of beta-blocker usage between sexes (75 vs 71% females, P=0.053). At both baseline and 12 weeks, females had a significantly lower body mass index, VO2peak, Wattpeak, BPmax and HRmax compared to males (P&amp;lt;0.001 for all) but a higher HRrest (P&amp;lt;0.001). However, both sexes had similar BPrest and SBP/MET-slope at baseline and 12 weeks. After 12 weeks of CR both males and females had a comparable mean±SD improvement in VO2peak (+4.1±3.2 and +3.1±2.6mL/kg/min), and Wattpeak (+33±22 and +22±15Watts), respectively (P&amp;lt;0.001 for all). This was associated with an increased SBPmax for males (171±30 to 181±30mmHg, P&amp;lt;0.001) and for females (159±29 to 167±30mmHg, P&amp;lt;0.001) from baseline to 12 weeks respectively. No change was seen in SBPrest between baseline and 12 weeks for males (128±20 to 128±19mmHg, P=0.39) and females (129±21 to 128±19mmHg, P=0.21) respectively. The SBP/MET-slope also remained unchanged after 12 weeks CR for males (8.97±5.48 to 9.04±4.81mmHg/MET, P=0.63) and for females (8.68±7.11 to 9.19±6.16mmHg/MET, P=0.13) respectively. Conclusion Twelve weeks of exercise-based CR was associated with an increase in SBPmax, although this was largely proportional to the improvement in exercise capacity demonstrated by the unchanged SBP/MET-slope and this was similar in both sexes. These routine clinical markers require further interrogation as to whether they parallel improvements in vascular health associated with exercise training.

Physiological and haemodynamic differences between peak exercise blood pressure and blood pressure-power output slope in healthy women

Abstract Background A hypertensive response to exercise (HRE) is considered indicative of increased arterial stiffness (1). However, HRE is common in individuals with high cardiorespiratory fitness (CRF) (2), which we hypothesize is due to increased stroke volume (SV) and cardiac output (Qc). Purpose This study compared differences in CRF and peak-exercise SV (SVpeak) and Qc (Qcpeak) according to absolute and workload-indexed definitions of exercise hypertension in women. Methods Women free of overt CVD (n=142; 52±8years, BMI: 26.3±4.5kg/m2) underwent exercise cardiac magnetic resonance to quantify SVpeak and Qcpeak, and cardiopulmonary exercise testing to quantify peak VO2, power output (PO) and systolic blood pressure (SBP) responses. SBP-PO slope was determined using linear regression of SBP and PO values obtained every 2-minutes throughout exercise. HRE was defined as peak SBP ≥190mmHg (3), and elevated SBP-PO slope was defined as a slope &amp;gt;90th percentile for sex and age based on previously published values (4). Results 51% and 23% of the cohort met criteria for HRE and elevated SBP-PO slope, respectively, with 16% meeting both criteria. HRE was associated with higher VO2peak (2.03±0.53 vs 1.83±0.44 L/min, P=0.015), peak PO (191±66 vs 167±51 Watts, P=0.014), SVpeak (109±27 vs 98±19 mLs, P=0.008), and Qcpeak (15.1±3.3 vs 13.9±2.8 L/min, P=0.023). In contrast, elevated SBP-PO slope was associated with lower VO2peak (1.57±0.36 vs 2.04±0.48 L/min), peak PO (135±34 vs 192±60Watts) SVpeak (88±13 vs 108±24 mLs) and Qcpeak (12.5±1.8 vs 15.1±3.1 L/min; P&amp;lt;0.001 for all). Overall, the group with HRE and elevated SBP-PO slope had the lowest physical capacity, VO2peak and haemodynamic response to exercise (Figure 1A-D), whilst the opposite trend was seen for those with a HRE and a normal SBP-PO slope. All results remained significant (P&amp;lt;0.05) after adjustment for age, BMI, resting SBP and menopausal status (pre vs peri/post-menopausal). Conclusion Contextualising exercise SBP responses against measures of PO better accounts for confounding from increased Qcpeak, and may improve identification of women with increased arterial stiffness.Figure 1A-D

Abstract 15558: Blood Pressure Responses During Exercise Were Associated With Average Home Blood Pressure and Home Blood Pressure Variability: The Electronic Framingham Heart Study

Introduction: Abnormal blood pressure (BP) responses during exercise are associated with incident hypertension and cardiovascular disease, but how exercise BP responses relate to average home BP and home BP variability (BPV) over one-year follow-up is unknown. Objective: We investigated whether exercise BP was associated with average home BP and home BPV, after accounting for resting BP, in the electronic Framingham Heart Study (eFHS). We hypothesized that higher exercise BP predicts higher average home BP and home BPV over one-year follow-up. Methods: At a FHS research exam (2016-2019), participants underwent maximum incremental ramp cycle ergometry cardiopulmonary exercise testing (CPET) with BP measured every two minutes. Participants enrolled in the eFHS were provided with a digital BP cuff to measure home BP weekly for up to one year. Linear regression models were used to examine associations of exercise BP with average home systolic BP (SBP) and week-to-week average real variability (ARV) of home SBP over one-year follow-up, adjusting for covariates. ARV, which considers both the dispersion and order of BP readings, was quantified as the average of the absolute differences between consecutive BP readings. We used p&lt;0.05 for significance. Results: The study sample included 806 participants (mean age 53 years, 58% women, 46% hypertension, median number of home BP returns 22, average home SBP 122 mmHg). Adjusting for resting SBP and other covariates, higher exercise SBP (as measured by peak SBP, SBP at 75 Watts, and SBP/workload slope) was associated with higher average home SBP ( Figure 1A ). Higher SBP/workload slope was associated with elevated ARV of home SBP in men ( Figure 1B ). Conclusion: Higher exercise SBP responses are associated with higher average digital home-based SBP and home-based SBP variability over one-year follow-up after accounting for resting SBP.