Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension

Abstract

Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension.

Exercise Blood Pressure and the Risk for Future Hypertension Among Normotensive Middle‐Aged Adults

“…For instance, no association was found between exaggerated BP response during treadmill tests and the development of hypertension in 3.5 years of follow-up. 13 Another study showed that the apparent relation between exercise SBP response and left ventricular mass is confounded by age, resting SBP, and body mass, questioning the relevance of positive echocardiographic findings reported in other studies. 14 In a 12-year follow-up of young Japanese adults, exaggerated SBP response during exercise was not associated with hypertension among women.…”

“…In addition, the great range of observation periods used by different studies has significantly influenced their various results. 13 Another concern was the doubts raised regarding the accuracy of BP measurements during exercise and the reproducibility of these results. 18 …”

“…In addition, the great range of observation periods used by different studies has significantly influenced their various results. 13 Another concern was the doubts raised regarding the accuracy of BP measurements during exercise and the reproducibility of these results. 18 Our study has several strengths that assisted in answering the abovementioned difficulties, and thus supported prior data regarding the association between the entities: First, our large number of subjects allowed stratification of the risk for hypertension by the levels of BP responses to exercise, while adjusting for multiple factors, including resting BP levels and habitual physical activity.…”

Exercise systolic blood pressure variability is associated with increased risk for new-onset hypertension among normotensive adults

“…18 However, the clinical role of exercise BP is still under evaluation, as there have been some conflicting results among various studies regarding the existence and magnitude of its association with future hypertension. [19][20][21] The field of BP variability has gained increased attention in recent decades, following a few large-scale studies linking long-term variability with higher probabilities for CVD and mortality. 2 Findings from a survey of the general US adult population comprising 956 individuals revealed that higher visit-to-visit variability in resting systolic but not diastolic BP predicted a greater risk for all-cause mortality.…”

Diagnostic Value of Electrocardiogram in Predicting Exaggerated Blood Pressure Response to Exercise Stress Testing

“…In general, research has shown that EBPR to exercise testing in people with no history of high blood pressure can increase the risk of blood pressure by 2 to 3 times ( 8 – 11 ). Some studies have also reported associations between EBPR to exercise testing and mortality as well as cardiovascular problems, albeit generally with no described mechanism ( 12 ).…”