Chronic Use of Antihypertensive Medications and Peak Exercise Blood Pressure in Adult Men and Women from the BALL ST Cohort

Abstract

ABSTRACT An excessive rise in systolic blood pressure (SBP) during exercise has been linked to increased risk of cardiovascular disease. Hypertensive individuals have been shown to have an exaggerated blood pressure (BP) response to exercise. However, research is limited on the impact of chronic antihypertensive medication use on the exercise BP response. Purpose To determine if individuals chronically (>1 yr) prescribed antihypertensive medications have a normal BP response to peak exercise compared with unmedicated individuals. Methods Participants included 2555 adults from the Ball State Adult Fitness Longitudinal Lifestyle STudy cohort who performed a peak treadmill exercise test. Participants were divided into groups by sex and antihypertensive medication status. Individuals prescribed antihypertensive medications for >1 yr were included. Exaggerated and blunted SBP within each group was categorized using the Fitness Registry and the Importance of Exercise: A National Database (FRIEND) and absolute criteria as noted by the American Heart Association. Results The unmedicated group had a greater prevalence (P < 0.05) of blunted SBP responses, whereas the medicated group had a higher prevalence (P < 0.05) of exaggerated SBP responses using both the FRIEND and absolute criteria. Peak SBP was higher (P < 0.01) in medicated compared with unmedicated participants in the overall cohort when controlling for age and sex, but not after controlling for resting SBP (P = 0.613), risk factors (P = 0.104), or cardiorespiratory fitness (P = 0.191). When men and women were assessed independently, peak SBP remained higher in the medicated women after controlling for age and resting SBP (P = 0.039), but not for men (P = 0.311). Individuals on beta-blockers had a higher peak SBP even after controlling for age, sex, risk factors, and cardiorespiratory fitness (P = 0.022). Conclusions Individuals on antihypertensive medications have a higher peak SBP response to exercise. Given the prognostic value of exaggerated peak SBP, control of exercise BP should be considered in routine BP assessment and in the treatment of hypertension.