title: Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study.
abstract: BACKGROUND
  Exercise blood pressure (BP) is an important marker of left ventricular hypertrophy, incident hypertension, and future cardiovascular events. Although impaired vascular function is hypothesized to influence the BP response during exercise, limited data exist on the association of vascular function with exercise BP in the community.
  
  
  RESULTS
  Framingham Offspring cohort participants (n=2115, 53% women, mean age 59 years) underwent a submaximal exercise test (first 2 stages of the Bruce protocol), applanation tonometry, and brachial artery flow-mediated dilation testing. We related exercise systolic and diastolic BP at second stage of the Bruce protocol to standard cardiovascular risk factors and to vascular function measures. In multivariable linear regression models, exercise systolic BP was positively related to age, standing BP, standing heart rate, smoking, body mass index, and the total cholesterol-to-high-density cholesterol ratio (P≤0.01 for all). Similar associations were observed for exercise diastolic BP. Carotid-femoral pulse wave velocity (P=0.02), central pulse pressure (P<0.0001), mean arterial pressure (P=0.04), and baseline brachial flow (P=0.002) were positively associated with exercise systolic BP, whereas flow-mediated dilation was negatively associated (P<0.001). For exercise diastolic BP, forward pressure wave amplitude was negatively related (P<0.0001), whereas mean arterial pressure was positively related (P<0.0001).
  
  
  CONCLUSIONS
  Increased arterial stiffness and impaired endothelial function are significant correlates of a higher exercise systolic BP response. Our findings suggest that impaired vascular function may contribute to exaggerated BP responses during daily living, resulting in repetitive increments in load on the heart and vessels and increased cardiovascular disease risk.
authors.affiliation: National Institutes of Health/National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA 01702, USA.
authors.forename: George
authors.initials: G
authors.lastname: Thanassoulis
authors.forename: Asya
authors.initials: A
authors.lastname: Lyass
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vita
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.forename: Michael E
authors.initials: ME
authors.lastname: Widlansky
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Donnell
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000502:physiology; D015331:Cohort Studies; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D014463:Ultrasonography; D059289:Vascular Stiffness / Q000502:physiology