Impact of exaggerated blood pressure response in normotensive individuals on future hypertension and prognosis: Systematic review according to PRISMA guideline

Keller, Karsten; Stelzer, Kathrin; Ostad, Mir Abolfazl; Post, Felix

doi:10.1016/j.advms.2016.11.010

Cited by 48 publications

(51 citation statements)

References 81 publications

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“…Older subjects also had higher SBP already at rest. Although all subjects were free from a diagnosis of hypertension and not on any anti-hypertensive medication, this may indicate subclinical or untreated hypertension in older subjects, manifested as an increase in peripheral vascular resistance already at rest, as well as a steeper SBP increase per W. As peak SBP has been found to be associated with the later development of manifest hypertension, 33 the SBP/ W-slope or peak SBP/W-ratio could constitute a more sensitive measure, although this remains to be investigated. .…”

Section: Effects Of Sex and Age On The Sbp Response To Exercisementioning

confidence: 99%

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Hedman

Lindow

Elmberg

et al. 2020

European Journal of Preventive Cardiology

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Background Guidelines recommend considering workload in interpretation of the systolic blood pressure (SBP) response to exercise, but reference values are lacking. Design This was a retrospective, consecutive cohort study. Methods From 12,976 subjects aged 18–85 years who performed a bicycle ergometer exercise test at one centre in Sweden during the years 2005–2016, we excluded those with prevalent cardiovascular disease, comorbidities, cardiac risk factors or medications. We extracted SBP, heart rate and workload (watt) from ≥ 3 time points from each test. The SBP/watt-slope and the SBP/watt-ratio at peak exercise were calculated. Age- and sex-specific mean values, standard deviations and 90th and 95th percentiles were determined. Reference equations for workload-indexed and peak SBP were derived using multiple linear regression analysis, including sex, age, workload, SBP at rest and anthropometric variables as predictors. Results A final sample of 3839 healthy subjects ( n = 1620 female) were included. While females had lower mean peak SBP than males (188 ± 24 vs 202 ± 22 mmHg, p < 0.001), workload-indexed SBP measures were markedly higher in females; SBP/watt-slope: 0.52 ± 0.21 versus 0.41 ± 0.15 mmHg/watt ( p < 0.001); peak SBP/watt-ratio: 1.35 ± 0.34 versus 0.90 ± 0.21 mmHg/watt ( p < 0.001). Age, sex, exercise capacity, resting SBP and height were significant predictors of the workload-indexed SBP parameters and were included in the reference equations. Conclusions These novel reference values can aid clinicians and exercise physiologists in interpreting the SBP response to exercise and may provide a basis for future research on the prognostic impact of exercise SBP. In females, a markedly higher SBP in relation to workload could imply a greater peripheral vascular resistance during exercise than in males.

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Section: Effects Of Sex and Age On The Sbp Response To Exercisementioning

confidence: 99%

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Hedman

Lindow

Elmberg

et al. 2020

European Journal of Preventive Cardiology

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“…It is controversial whether the hypertensive response to exercise (HTR) has independent or additive prognostic value. Several previous studies have demonstrated that HTR is an independent predictor of left ventricular (LV) hypertrophy, endothelial function, and future development of hypertension and cardiovascular events . However, one study revealed that HTR did not have incremental predictive value for cardiovascular events over resting BP .…”

Section: Introductionmentioning

confidence: 97%

Arterial stiffness, sex, and age difference on hypertensive response to supine bicycle exercise

Chung

Kim

Lee

et al. 2017

J of Clinical Hypertension

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Contributors to a hypertensive response to exercise (HTR) according to sex and age have not been fully evaluated. The authors analyzed a database of supine bicycle exercise stress echocardiography findings. HTR was defined as peak systolic blood pressure ≥210 mmHg for men and ≥190 mmHg for women during exercise. A total of 797 patients (306 [38%] women) were analyzed, with a mean age of 64 ± 10 years. Female sex, hypertension; higher left ventricular ejection fraction, effective arterial elastance, and pulse wave velocity; and lower total arterial compliance were significantly related to HTR. Patients with HTR had higher relative wall thickness, ratio of early diastolic mitral inflow and annular velocity, and diastolic elastance (all P ≤ .05). In multivariable analysis, indices of arterial stiffness such as pulse wave velocity, arterial elastance, total arterial compliance, and systemic vascular resistance were more strongly related in women, while in men, index of sympathetic activation was additionally related to HTR (all P ≤ .05). Female sex and lower total arterial compliance in older patients (≥65 years) and higher systemic vascular resistance and left ventricular relative wall thickness in younger patients were more strongly related to HTR. In conclusion, HTR was related to arterial stiffness, sympathetic activation, and diastolic dysfunction; however, the associations were different according to sex and age, which might guide individualized therapy.

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“…These thresholds approximate the 90th percentile in young, healthy subjects, [3][4][5] but are not consistently associated with outcome. In fact, systematic reviews and meta-analyses [6][7][8] suggest a complex and somewhat ambiguous association between the SBP response to exercise and mortality. In some populations, a high peak SBP has been related to a lower risk of future cardiovascular events and all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality

Hedman

Cauwenberghs

Christle

et al. 2019

Eur J Prev Cardiolog

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Aims The association between peak systolic blood pressure (SBP) during exercise testing and outcome remains controversial, possibly due to the confounding effect of external workload (metabolic equivalents of task (METs)) on peak SBP as well as on survival. Indexing the increase in SBP to the increase in workload (SBP/MET-slope) could provide a more clinically relevant measure of the SBP response to exercise. We aimed to characterize the SBP/MET-slope in a large cohort referred for clinical exercise testing and to determine its relation to all-cause mortality. Methods and results Survival status for male Veterans who underwent a maximal treadmill exercise test between the years 1987 and 2007 were retrieved in 2018. We defined a subgroup of non-smoking 10-year survivors with fewer risk factors as a lower-risk reference group. Survival analyses for all-cause mortality were performed using Kaplan–Meier curves and Cox proportional hazard ratios (HRs (95% confidence interval)) adjusted for baseline age, test year, cardiovascular risk factors, medications and comorbidities. A total of 7542 subjects were followed over 18.4 (interquartile range 16.3) years. In lower-risk subjects ( n = 709), the median (95th percentile) of the SBP/MET-slope was 4.9 (10.0) mmHg/MET. Lower peak SBP (<210 mmHg) and higher SBP/MET-slope (>10 mmHg/MET) were both associated with 20% higher mortality (adjusted HRs 1.20 (1.08–1.32) and 1.20 (1.10–1.31), respectively). In subjects with high fitness, a SBP/MET-slope > 6.2 mmHg/MET was associated with a 27% higher risk of mortality (adjusted HR 1.27 (1.12–1.45)). Conclusion In contrast to peak SBP, having a higher SBP/MET-slope was associated with increased risk of mortality. This simple, novel metric can be considered in clinical exercise testing reports.

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Impact of exaggerated blood pressure response in normotensive individuals on future hypertension and prognosis: Systematic review according to PRISMA guideline

Cited by 48 publications

References 81 publications

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Arterial stiffness, sex, and age difference on hypertensive response to supine bicycle exercise

Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality

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