Exercise blood pressure and cardiovascular disease risk: a systematic review and meta-analysis of cross-sectional studies

Abstract

Background: A hypertensive response to exercise (HRE) is associated with cardiovascular disease and high blood pressure (BP). A poor cardiovascular risk factor profile may underlie these associations, although this has not been systematically elucidated. Via systematic review and metaanalysis, we aimed to assess the relationship between exercise BP and cardiovascular risk factors, and determine if cardiovascular risk is higher in those with an HRE vs. no-HRE across different study populations (including those with/without high BP at rest).Methods: Three online databases were searched for crosssectional studies reporting data on exercise BP, an HRE and cardiovascular risk factors (including arterial structure, lipid, metabolic, inflammatory and kidney function markers). Random-effects meta-analyses and meta-regression were used to calculate pooled correlations between exercise BP and each risk factor and pooled mean differences between those with/without an HRE.Results: Thirty-eight studies (38 295 participants, aged 50 AE 3years; 78% male) were included. Exercise SBP was associated with arterial, lipid and kidney function risk markers (P < 0.05). Those with an HRE had greater aortic stiffness (R0.80 AE 0.35 m/s), total (R0.14 AE 0.03 mmol/l) and low-density lipoprotein (R0.12 AE 0.03 mmol/l) cholesterol, triglycerides (R0.24 AE 0.04 mmol/l), glucose (R0.15 AE 0.05 mmol/l), white blood cell count (R0.49 AE 0.16 mmol/l) and albumin-to-creatinine ratio (standardized mean difference: R0.97 AE 0.34), and lower flow-mediated dilation (À4.13 AE 1.02%) and high-density lipoprotein cholesterol (À0.04 AE 0.01 mmol/l) vs. those with no-HRE (P < 0.05 all). Results were broadly similar across study populations. Conclusion:Exercise SBP is associated with multiple cardiovascular risk factors, which appear worse in those with an HRE vs. no-HRE. As results were similar across population groups, an HRE should be considered an important indicator of cardiovascular risk.

Exploring the direct and indirect effects of cardiovascular disease risk factors on exercise blood pressure

“…Exercise systolic and diastolic BP were analyzed as a continuous variable because of substantial heterogeneity on thresholds used to define an exaggerated BP response to exercise. 4,5 Analyses used to remove skewness in exercise BP and assess linearity and age-and sex-interactions in associations between exercise BP and each study factor are described in supplementary material (page 5). All associations were adjusted for age and sex.…”

“…The statistical methods used in this study are distinctly different to those in previous studies that have investigated the relationship between exercise BP and various CVD risk factors via traditional linear models (i.e., Pearson's correlation or regression). 4,8,9 A limitation of previous findings and traditional statistical methods is that the association between exercise BP and a individual CVD risk factor may be indirect via a relationship with another factor. The novelty of this study is the SEM utilized enabled simultaneously tested multiple pathways of association between exercise BP and different CVD risk factors.…”

“…1 This systolic BP response during submaximal intensity can, however, be exaggerated, which pooled data indicate is independently associated with incident hypertension, cardiovascular morbidity, and mortality. 2,3 An exaggerated BP response during submaximal intensity exercise is also associated with other hypertension-related cardiovascular disease (CVD) risk factors (e.g., raised left ventricular mass and aortic stiffness), 4,5 likely because it represents a state of chronic hypertension gone undetected with standard measurement of BP at rest. 6,7 Thus, submaximal exercise BP may be a useful clinical tool to identify CVD risk.…”

Type-2 Diabetes and the Clinical Importance of Exaggerated Exercise Blood Pressure

“…9,19 Underlying these associations are known relationships to CVD risk markers and abnormal cardiac structure. 7,20 Moreover, people with established T2DM are at increased CVD risk related to poor BP control that is not always recognized from clinic BP measurements at rest. 4 People with T2DM have higher prevalence of masked hypertension (ie, normal clinic BP but raised out-of-clinic BP), reported to be up to 30%.…”

“…9,19 Underlying these associations are known relationships to CVD risk markers and abnormal cardiac structure. 7,20 Moreover, people with established T2DM are at increased CVD risk related to poor BP control that is not always recognized from clinic BP measurements at rest. 4…”