(Circulation. 1999;99:1831-1836.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Blood Pressure Response During Treadmill Testing as a Risk Factor for New-Onset Hypertension
The Framingham Heart Study
From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass (J.P.S., M.G.L., J.C.E., C.J.O., D.L.); the National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M., C.J.O., D.L.); the Division of Epidemiology and Preventive Medicine, Boston University School of Medicine, Boston, Mass (J.P.S., M.G.L., J.C.E., D.L.); the Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio (M.L.); and the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital (D.L.), and Department of Medicine, Massachusetts General Hospital, Harvard Medical School (J.P.S., C.J.O), Boston.
Correspondence to Daniel Levy, MD, Framingham Heart Study, 5 Thurber St, Framingham, MA 01702. E-mail dan{at}fram.nhlbi.nih.gov
Background—Although systolic blood pressure (SBP) response to exercise has been shown to predict subsequent hypertension in small samples of men, this association has not been studied in a large population-based sample of middle-aged men and women. The purpose of this study was to examine, in normotensive subjects, the relations of SBP and diastolic blood pressure (DBP) during the exercise and recovery periods of a graded treadmill test to the risk of developing new-onset hypertension.
Methods and Results—BP data from exercise testing in 1026 men and
1284 women (mean age, 42±10 years; range, 20 to 69 years) from the
Framingham Offspring Study who were normotensive at baseline were
related to the incidence of hypertension 8 years later. New-onset
hypertension, defined as an SBP 
140 mm Hg or DBP 90
mm Hg or the initiation of antihypertensive drug treatment, occurred
in 228 men (22%) and 207 women (16%). Exaggerated SBP (Ex-SBP 2) and
DBP (Ex-DBP 2) response and delayed recovery of SBP (R-SBP 3) and DBP
(R-DBP 3) were defined as an age-adjusted BP greater than the 95th
percentile during the second stage of exercise and third minute of
recovery, respectively. After multivariable adjustment, Ex-DBP 2
was highly predictive of incident hypertension in both men (OR, 4.16;
95% CI, 2.15, 8.05) and women (OR, 2.17; CI, 1.19, 3.96). R-SBP 3 was
predictive of hypertension in men in a multivariable model that
included exercise duration and peak exercise BP (OR, 1.92; CI, 1.00,
3.69). Baseline resting SBP (
2, 23.4 in men and 34.7 in
women) and DBP (2, 11.3 in men and 13.1 in women) had
stronger associations with new-onset hypertension than exercise DBP
(2, 16.4 in men and 6.1 in women) and recovery SBP
(2, 6.5 in men and 2.1 in women) responses.
Conclusions—An exaggerated DBP response to exercise was predictive of risk for new-onset hypertension in normotensive men and women. An elevated recovery SBP was predictive of hypertension in men. These findings may reflect subtle pathophysiological features in the preclinical stage of hypertension.
Key Words: tests • hypertension • trials
This article has been cited by other articles:
 |
|
 |
|
  J. E. Sharman, C. M. McEniery, R. Campbell, P. Pusalkar, I. B. Wilkinson, J. S. Coombes, and J. R. Cockcroft Nitric Oxide Does Not Significantly Contribute to Changes in Pulse Pressure Amplification During Light Aerobic Exercise Hypertension, April 1, 2008; 51(4): 856 - 861. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. K. Gilliam, J. P. Palmer, and G. J. Taborsky Jr. Tyramine-Mediated Activation of Sympathetic Nerves Inhibits Insulin Secretion in Humans J. Clin. Endocrinol. Metab., October 1, 2007; 92(10): 4035 - 4038. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hamer and A. Steptoe Association Between Physical Fitness, Parasympathetic Control, and Proinflammatory Responses to Mental Stress Psychosom Med, September 1, 2007; 69(7): 660 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 X. Bao, C. M. Lu, F. Liu, Y. Gu, N. D. Dalton, B.-Q. Zhu, E. Foster, J. Chen, J. S. Karliner, J. Ross Jr, et al. Epinephrine Is Required for Normal Cardiovascular Responses to Stress in the Phenylethanolamine N-Methyltransferase Knockout Mouse Circulation, August 28, 2007; 116(9): 1024 - 1031. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Ingelsson, M. G. Larson, R. S. Vasan, C. J. O'Donnell, X. Yin, J. N. Hirschhorn, C. Newton-Cheh, J. A. Drake, S. L. Musone, N. L. Heard-Costa, et al. Heritability, Linkage, and Genetic Associations of Exercise Treadmill Test Responses Circulation, June 12, 2007; 115(23): 2917 - 2924. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Jakulj, K. Zernicke, S. L. Bacon, L. E. van Wielingen, B. L. Key, S. G. West, and T. S. Campbell A High-Fat Meal Increases Cardiovascular Reactivity to Psychological Stress in Healthy Young Adults J. Nutr., April 1, 2007; 137(4): 935 - 939. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Ou, E. Mousseaux, D. S. Celermajer, E. Pedroni, P. Vouhe, D. Sidi, and D. Bonnet Aortic arch shape deformation after coarctation surgery: effect on blood pressure response. J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1105 - 1111. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Brassard, A. Ferland, V. Gaudreault, N. Bonneville, J. Jobin, and P. Poirier Elevated peak exercise systolic blood pressure is not associated with reduced exercise capacity in subjects with Type 2 diabetes J Appl Physiol, September 1, 2006; 101(3): 893 - 897. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Steptoe and M. Marmot Psychosocial, Hemostatic, and Inflammatory Correlates of Delayed Poststress Blood Pressure Recovery Psychosom Med, July 1, 2006; 68(4): 531 - 537. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Hautala, T. Rankinen, A. M. Kiviniemi, T. H. Makikallio, H. V. Huikuri, C. Bouchard, and M. P. Tulppo Heart rate recovery after maximal exercise is associated with acetylcholine receptor M2 (CHRM2) gene polymorphism Am J Physiol Heart Circ Physiol, July 1, 2006; 291(1): H459 - H466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Sharman, R. Lim, A. M. Qasem, J. S. Coombes, M. I. Burgess, J. Franco, P. Garrahy, I. B. Wilkinson, and T. H. Marwick Validation of a Generalized Transfer Function to Noninvasively Derive Central Blood Pressure During Exercise Hypertension, June 1, 2006; 47(6): 1203 - 1208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kurl, J.A. Laukkanen, L. Niskanen, R. Rauramaa, T.P. Tuomainen, J. Sivenius, and J.T. Salonen Cardiac Power During Exercise and the Risk of Stroke in Men Stroke, April 1, 2005; 36(4): 820 - 824. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Madias Blunted Decline in Systolic Blood Pressure After Exercise Predicts Future Acute Myocardial Infarction Hypertension, December 1, 2004; 44(6): 807 - 808. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Laukkanen, S. Kurl, R. Salonen, T. A. Lakka, R. Rauramaa, and J. T. Salonen Systolic Blood Pressure During Recovery From Exercise and the Risk of Acute Myocardial Infarction in Middle-Aged Men Hypertension, December 1, 2004; 44(6): 820 - 825. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Mottram, B. Haluska, R. Leano, D. Cowley, M. Stowasser, and T. H. Marwick Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure Circulation, August 3, 2004; 110(5): 558 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Mottram, B. Haluska, S. Yuda, R. Leano, and T. H. Marwick Patients with a hypertensive response to exercise have impaired systolic function without diastolic dysfunction or left ventricular hypertrophy J. Am. Coll. Cardiol., March 3, 2004; 43(5): 848 - 853. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Committee Members, R. J. Gibbons, G. J. Balady, J. Timothy Bricker, B. R. Chaitman, G. F. Fletcher, V. F. Froelicher, D. B. Mark, B. D. McCallister, A. N. Mooss, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: A report of the American college of cardiology/American heart association task force on practice guidelines (committee to update the 1997 exercise testing guidelines) J. Am. Coll. Cardiol., October 16, 2002; 40(8): 1531 - 1540. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, G. J. Balady, J. Timothy Bricker, B. R. Chaitman, G. F. Fletcher, V. F. Froelicher, D. B. Mark, B. D. McCallister, A. N. Mooss, M. G. O'Reilly, et al. ACC/AHA 2002 Guideline Update for Exercise Testing: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines) Circulation, October 1, 2002; 106(14): 1883 - 1892. [Full Text] [PDF]
|
|
|
|
|
|
N. Miyai, M. Arita, K. Miyashita, I. Morioka, T. Shiraishi, and I. Nishio Blood Pressure Response to Heart Rate During Exercise Test and Risk of Future Hypertension Hypertension, March 1, 2002; 39(3): 761 - 766. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Fletcher, G. J. Balady, E. A. Amsterdam, B. Chaitman, R. Eckel, J. Fleg, V. F. Froelicher, A. S. Leon, I. L. Pina, R. Rodney, et al. Exercise Standards for Testing and Training: A Statement for Healthcare Professionals From the American Heart Association Circulation, October 2, 2001; 104(14): 1694 - 1740. [Full Text] [PDF]
|
|
|
|
|
|
S. Kurl, J. A. Laukkanen, R. Rauramaa, T. A. Lakka, J. Sivenius, and J. T. Salonen Systolic Blood Pressure Response to Exercise Stress Test and Risk of Stroke Stroke, September 1, 2001; 32(9): 2036 - 2041. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Miyai, M. Arita, I. Morioka, K. Miyashita, I. Nishio, and S. Takeda Exercise BP response in subjects with high-normal BP: Exaggerated blood pressure response to exercise and risk of future hypertension in subjects with high-normal blood pressure J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1626 - 1631. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Bouchart, A. Dubar, A. Tabley, P. Y. Litzler, C. Haas-Hubscher, M. Redonnet, J. P. Bessou, and R. Soyer Coarctation of the aorta in adults: surgical results and long-term follow-up Ann. Thorac. Surg., November 1, 2000; 70(5): 1483 - 1488. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 BP Surge on Exercise Testing Predicts Hypertension Journal Watch (General), April 23, 1999; 1999(423): 5 - 5. [Full Text]
|
|