Blood Pressure Responses During Exercise: Physiological Correlates and Clinical Implications.
Matthew Nayor, Priya Gajjar, Venkatesh L Murthy, Patricia E Miller, Raghava S Velagaleti, Martin G Larson, Ramachandran S Vasan, Gregory D Lewis, Gary F Mitchell, Ravi V Shah
Author Information
Matthew Nayor: Cardiovascular Medicine Section (M.N., P.G., R.S. Vasan), Boston University School of Medicine, MA. ORCID
Priya Gajjar: Cardiovascular Medicine Section (M.N., P.G., R.S. Vasan), Boston University School of Medicine, MA.
Venkatesh L Murthy: Division of Cardiovascular Medicine, Department of Medicine (V.L.M.), University of Michigan, Ann Arbor. ORCID
Patricia E Miller: Department of Medicine, and Department of Biostatistics (P.E.M., M.G.L.), Boston University School of Medicine, MA.
Raghava S Velagaleti: Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (M.N., R.S. Vasan, M.G.L., R.S. Velagaleti). ORCID
Martin G Larson: Department of Medicine, and Department of Biostatistics (P.E.M., M.G.L.), Boston University School of Medicine, MA.
Ramachandran S Vasan: Cardiovascular Medicine Section (M.N., P.G., R.S. Vasan), Boston University School of Medicine, MA. ORCID
Gregory D Lewis: Cardiology Division and Pulmonary Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.D.L.). ORCID
Gary F Mitchell: Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.). ORCID
Ravi V Shah: Cardiovascular Medicine Section (M.N., P.G., R.S. Vasan), Boston University School of Medicine, MA. ORCID
BACKGROUND: Abnormal blood pressure (BP) responses to exercise can predict adverse cardiovascular outcomes, but their optimal measurement and definitions are poorly understood. We combined frequently sampled BP during cardiopulmonary exercise testing with vascular stiffness assessment to parse cardiac and vascular components of exercise BP. METHODS: Cardiopulmonary exercise testing with BP measured every two minutes and resting vascular tonometry were performed in 2858 Framingham Heart Study participants. Linear regression was used to analyze sex-specific exercise BP patterns as a function of arterial stiffness (carotid-femoral pulse wave velocity) and cardiac-peripheral performance (defined by peak O pulse). RESULTS: Our sample was balanced by sex (52% women) with mean age 54±9 years and 47% with hypertension. We observed variability in carotid-femoral pulse wave velocity and peak O pulse across individuals with clinically defined exercise hypertension (peak systolic BP [SBP] in men ≥210 mm Hg; in women ≥190 mm Hg). Despite similar resting SBP and cardiometabolic profiles, individuals with higher peak O pulse displayed higher peak SBP (≤0.017) alongside higher fitness levels (<0.001), suggesting that high peak exercise SBP in the context of high peak O pulse may in fact be favorable. Although both higher (favorable) O pulse and higher (adverse) arterial stiffness were associated with greater peak SBP (<0.0001 for both), the magnitude of association of carotid-femoral pulse wave velocity with peak SBP was higher in women (sex-carotid-femoral pulse wave velocity interaction <0.0001). In sex-specific models, exercise SBP measures accounting for workload (eg, SBP during unloaded exercise, SBP at 75 watts, and SBP/workload slope) were directly associated with the adverse features of greater arterial stiffness and lower peak O pulse. CONCLUSIONS: Higher peak exercise SBP reflects a complex trade-off between arterial stiffness and cardiac-peripheral performance that differs by sex. Studies of BP responses to exercise accounting for vascular and cardiac physiology may illuminate mechanisms of hypertension and clarify clinical interpretation of exercise BP.
