Abstract 10714: Elevated Systolic Blood Pressure Reactivity Before Exercise Stress Testing is Associated With the Risk of Hypertension in Healthy Men

Abstract

Heightened cardiovascular reactivity has been associated with incident hypertension, but whether systolic blood pressure (SBP) reactivity prior to exercise stress testing is associated with incidence of hypertension in healthy men is not known. We tested the hypothesis that SBP reactivity prior to exercise stress testing is inversely associated with the incidence of hypertension in middle aged healthy men. Subjects were 3814 men (mean age 48±6 yrs) who participated in two health examinations during 1998-2009. All subjects were free of cardiovascular diseases and hypertension at baseline. Seated resting blood pressure in a quiet room and blood pressure at the beginning of treadmill exercise stress testing were measured. The reactivity in blood pressure was calculated as the difference between resting SBP and SBP immediately before exercise stress testing. Hypertension was defined as systolic and diastolic blood pressure ≥140/90mmHg. During an average follow-up of 5 years, 371 (9.7%) subjects developed hypertension. The incidence of hypertension was inversely associated with changes in SBP quartiles (Q1 (<-4mmHg) (decreased) 7.9%, Q2 (-4∼0mmHg) 10.0%, Q3 (0∼9mmHg) 10.4%, and Q4 (>9mmHg) (increased) 10.8%; P <0.05 for trend). Subjects with exaggerated systolic reactivity (>9mmHg) had a 2.8-fold (95% CI, 2.1 -3.8) risk of developing hypertension as compared to subjects with low SBP reactivity (<-4mmHg) after adjustment for age, BMI, SBP, TC, HDL-C, TG, glucose, WBC, resting HR, VO2peak, smoking and alcohol intake. Each increment in SBP (1 mmHg) was associated with 4% (RR 1.04, 95% CI 1.03-1.05) higher incidence of hypertension after adjustment for risk factors. These results demonstrate that excessive sympathetic reactivity before exercise stress test is associated with incident hypertension independent of risk factors in healthy men. The assessment of SBP reactivity may be a useful addition to standard exercise stress testing procedures.