Exercise systolic blood pressure at moderate workload predicts cardiovascular disease and mortality through 35 years of follow-up in healthy, middle-aged men

Mariampillai, Julian E.; Engeseth, Kristian; Kjeldsen, Sverre E.; Grundvold, Irene; Liestøl, Knut; Erikssen, Gunnar; Erikssen, Jan; Bodegård, Johan; Skretteberg, Per Torger

doi:10.1080/08037051.2017.1291276

Cited by 20 publications

(10 citation statements)

References 93 publications

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“…Our findings add to the growing amount of evidence that physical fitness and other parameters derived from exercise testing are important cardiovascular risk predictors. 3–6,10,19–22 Our findings also indicate that a single measurement of maximal physical fitness is a time-limited powerful cardiovascular risk predictor, and we substantiated that repeated physical fitness measurements may be valuable for assessing a patient’s risk profile over time. Physical fitness is easily measured by ergometer or treadmill exercise testing, and allows self-assessment of the intensity of endurance training using commonly available exercise monitoring equipment such as watches, smart phone applications, treadmills and other gym facility training machines.…”

Section: Discussionsupporting

confidence: 68%

“…Risk predictors derived from exercise testing have gained interest, and are now important complements to classical risk factors such as family history, smoking, blood pressure and cholesterol. [2][3][4][5][6][7] Physical fitness and physical activity level, measured during exercise testing and self-reported, have previously been shown to predict cardiovascular death and disease; hence measurement of physical fitness and activity level could improve cardiovascular risk stratification. [8][9][10][11][12][13] However, an individual's level of physical fitness may vary from year to year due to changes in health, lifestyle and physical activity level.…”

Section: Introductionmentioning

confidence: 99%

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Physical fitness is a modifiable predictor of early cardiovascular death: A 35-year follow-up study of 2014 healthy middle-aged men

Engeseth

Prestgaard

Mariampillai

et al. 2018

Eur J Prev Cardiolog

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Background Physical fitness has been shown to predict cardiovascular death during long-term follow-up. In the present study we aimed to investigate how physical fitness and other cardiovascular risk factors at middle-age influenced the risk of cardiovascular death during the early (0-11 years), intermediate (12-23 years) and late (24-35 years) parts of a 35-year observation period. Methods and results Age-adjusted physical fitness was calculated in 2014 apparently healthy, middle-aged men after maximal bicycle electrocardiogram-tests in 1972-1975 (Survey 1) and 1979-1982 (Survey 2). The men were assessed through 35 years after Survey 1, and 28 years after Survey 2 by Cox proportional hazards models. Low Survey 1 physical fitness was independently associated with increased risks of early and intermediate, but not late, cardiovascular death. Survey 1 to Survey 2 change in physical fitness, age, smoking status, systolic blood pressure and cholesterol impacted cardiovascular death risks in all periods. Family history of coronary heart disease impacted early and intermediate, but not late, cardiovascular death. Conclusions Most classical cardiovascular risk factors were strong predictors of early, intermediate and late cardiovascular death. Physical fitness measured at median age 50 years was independently associated with risk of early cardiovascular death, but the association weakened as time progressed. Change in physical fitness during middle-age impacted cardiovascular death risk in a full lifetime perspective. Thus, our data suggest that physical fitness is a modifiable cardiovascular risk factor with limited duration in contrast to the sustained impact of smoking, blood pressure and cholesterol on cardiovascular mortality.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Physical fitness is a modifiable predictor of early cardiovascular death: A 35-year follow-up study of 2014 healthy middle-aged men

Engeseth

Prestgaard

Mariampillai

et al. 2018

Eur J Prev Cardiolog

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“…In preventive cardiology, improved cardiovascular prediction is important in order to choose appropriate risk‐modifying strategies. Risk predictors derived from exercise testing have gained interest and are now important complements to classical risk factors, such as smoking, blood pressure, and cholesterol . One established exercise‐derived cardiovascular predictor is the chronotropic index ([achieved maximal heart rate−resting heart rate]/[age‐predicted maximal heart rate−resting heart rate]), which is a standardized measure of heart rate (HR) change during exercise that reflects the combined effects of age, resting HR, and physical fitness (PF) .…”

Section: Introductionmentioning

confidence: 99%

Temporal Reduction in Chronotropic Index Predicts Risk of Cardiovascular Death Among Healthy Middle‐Aged Men: a 28‐Year Follow‐Up Study

Engeseth

Hodnesdal

Grundvold

et al. 2016

JAHA

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BackgroundChronotropic index is a standardized measure of heart rate (HR) increment during exercise that reflects the combined effects of age, resting HR, and physical fitness. Low chronotropic index has been reported to predict disease and death. We tested whether temporal change in chronotropic index over 7 years influenced risk of cardiovascular death through up to 28 years.Methods and ResultsChronotropic index was calculated ([achieved maximal HR−resting HR]/[age‐predicted maximal HR−resting HR]) after a symptom‐limited bicycle ECG exercise test in 1420 healthy men at 2 examinations 7 years apart, in 1972 and 1979. Events of cardiovascular death were registered by manual scrutiny of all participants’ hospital charts and the Norwegian Cause of Death Registry. The participants were divided into quartiles of temporal change in chronotropic index, with quartile one having the most negative value. Cox proportional hazard regression models were used to estimate risks and adjusted for classical cardiovascular risk factors. Incidence of cardiovascular death was 310 (22%) during median of 21 years of follow‐up. After multivariable adjustment, and comparison with quartile four (mean +0.11), quartiles one (−0.16), two (−0.04), and three (+0.02) were associated with hazard ratios 1.50 (95% CI 1.10–2.05), 1.10 (0.79–1.53), and 1.04 (0.74–1.45) for cardiovascular death. Results remained robust also after exclusion of 31 participants with exercise ECG‐induced signs of coronary ischemia.ConclusionsTemporal reduction in chronotropic index was associated with increased long‐term risk of cardiovascular death and might be a clinically important predictor when assessing risk in healthy individuals over a longer time.

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“…The pooled analysis indicated EEBP during various intensities of submaximal exercise was associated with a 36% increased cardiovascular event and mortality rate, with each 10-mmHg increase in systolic BP during submaximal exercise intensities associated with a 4% increased event rate independent of resting BP, age, sex, and other CVD risk factors [ 5 ]. More recent longitudinal studies and a further meta-analysis have confirmed the CVD risk associated with EEBP during submaximal exercise [ 25 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 93%

The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance

Schultz

Currie

Hedman

et al. 2022

IJERPH

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High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identification of high BP is conventionally based on in-clinic (resting) BP measures, performed within primary health care settings. However, many cases of high BP go unrecognised or remain inadequately controlled. Thus, there is a need for complementary settings and methods for BP assessment to identify and control high BP more effectively. Exaggerated exercise BP is associated with increased CVD risk and may be a medium to improve identification and control of high BP because it is suggestive of high BP gone undetected on the basis of standard in-clinic BP measures at rest. This paper provides the evidence to support a pathway to aid identification and control of high BP in clinical exercise settings via the measurement of exercise BP. It is recommended that exercise professionals conducting exercise testing should measure BP at a fixed submaximal exercise workload at moderate intensity (e.g., ~70% age-predicted heart rate maximum, stage 1–2 of a standard Bruce treadmill protocol). If exercise systolic BP is raised (≥170 mmHg), uncontrolled high BP should be assumed and should trigger correspondence with a primary care physician to encourage follow-up care to ascertain true BP control (i.e., home, or ambulatory BP) alongside a hypertension-guided exercise and lifestyle intervention to lower CVD risk related to high BP.

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Exercise systolic blood pressure at moderate workload predicts cardiovascular disease and mortality through 35 years of follow-up in healthy, middle-aged men

Abstract: The results of this study suggest that the association between exercise SBP at moderate workload and cardiovascular disease and mortality in middle-aged men extends through as long as 35 years and into old ages.

Cited by 20 publications

References 93 publications

Physical fitness is a modifiable predictor of early cardiovascular death: A 35-year follow-up study of 2014 healthy middle-aged men

Physical fitness is a modifiable predictor of early cardiovascular death: A 35-year follow-up study of 2014 healthy middle-aged men

Temporal Reduction in Chronotropic Index Predicts Risk of Cardiovascular Death Among Healthy Middle‐Aged Men: a 28‐Year Follow‐Up Study

The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance

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