Physicians' Academy for Cardiovascular Education

Long-term increase of systolic blood pressure upon exercise is a CV risk factor

Literature - Skretteberg PT, Grundvold I, Kjeldsen SE et al. - Hypertension. 2013 May;61(5):1134-40.


Seven-year increase in exercise systolic blood pressure at moderate workload predicts long-term risk of coronary heart disease and mortality in healthy middle-aged men.

 
Skretteberg PT, Grundvold I, Kjeldsen SE et al.
Hypertension. 2013 May;61(5):1134-40. doi: 10.1161/HYPERTENSIONAHA.111.00793
 

Background

Systolic blood pressure (SBP) in response to exercise can predict cardiovascular (CV) disease and mortality, although SBP measured at low or moderate exercise seems to be of higher predictive value than SBP measured at maximum effort [1-4]. Exercise SBP at 100 W workload (=5.5 metabolic equivalents) (SBP100W) predicts coronary heart disease (CHD) death and CV death [2,5]. Temporal changes in SBP100W have also been studied [6], but the prognostic value of changes in exercise BP on risk of CV disease and mortality is unknown.
This study investigated the relationship between ΔSBP100W over 7 years and future CHD, and CHD or CV death, and all-cause death, in 1392 apparently healthy men. Men were divided into quartiles of change in SBP.
 

Main results

  • Mean resting SBP at survey 1 was 127.2 mmHg and mean SBP100W was 177.3 mmHg. At survey 2, mean SBP had increased with 3.4 mmHg and SBP100W with 3.0 mmHg.
  • ΔSBP100W significantly predicted CHD, as well as CHD death, CV death can all-cause death both in univariate and multivariate analyses correcting for classical CV risk factors.
  • 32.5% of 1392 men suffered from CHD during 27.7 years of follow up. Incidence of CHD, CHD death, CV death and all-cause death increased with increasing ΔSBP100W-quartiles.
  • Relative risk of CHD increased with increasing ΔSBP100W-quartiles. Q4 was also associated with higher risk of CHD or CV death, or all-cause death, as compared to the lowest ΔSBP100W quartile. Some of the observed effects were lost upon further correction for physical fitness and changes therein.
  • In a subgroup of 691 normotensive men, the highest ΔSBP100W-category showed hazard ratios of 1.77 (1.13-2.76) adjusted risk of CHD death, HR 2.15 (1.19-3.84) for CV death and HR 1.48 (1.03-2.11) for all-cause death, as compared to the lowest category.
 

Conclusion

Change in SBP100W over a period of 7 years, was found to predict long-term CHD, CHD death, CV death and all-cause death, when corrected for classical CV risk factors. Physical fitness and temporal changes therein attenuated these associations. These findings indicate that high SBP upon exercise is a risk factor for CHD in healthy men.
 

References

1. Kjeldsen SE, Mundal R, Sandvik L, et al. J. Exercise blood pressure predicts cardiovascular death and myocardial infarction. Blood Press Monit. 1997;2:147–153.
2. Mundal R, Kjeldsen SE, Sandvik L, et al. Exercise blood pressure predicts cardiovascular mortality in middle-aged men. Hypertension. 1994;24:56–62.
3. Weiss SA, Blumenthal RS, Sharrett AR, et al. Exercise blood pressure and future cardiovascular death in asymptomatic individuals. Circulation. 2010;121:2109–2116.
4. Erikssen G, Bodegard J, Bjørnholt JV, et al. Exercise testing of healthy men in a new perspective: from diagnosis to prognosis. Eur Heart J. 2004;25:978–986.
5. Mundal R, Kjeldsen SE, Sandvik L, et al. J. Exercise blood pressure predicts mortality from myocardial infarction.Hypertension. 1996;27(3 pt 1):324–329.
6. Mundal R, Kjeldsen SE, Sandvik L, et al. Predictors of 7-year changes in exercise blood pressure: effects of smoking, physical fitness and pulmonary function. J Hypertens. 1997;15:245–249.
 

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