Association of Blood Pressure Responses to Submaximal Exercise in Midlife With the Incidence of Cardiovascular Outcomes and All‐Cause Mortality: The Framingham Heart Study

Abstract

Background Few studies examined the associations of midlife blood pressure ( BP ) responses to submaximal exercise with the risk of cardiovascular outcomes and mortality in later life. Methods and Results We evaluated 1993 Framingham Offspring Study participants (mean age, 58 years; 53.2% women) attending examination cycle 7. We related BP responses to submaximal exercise with prevalent subclinical cardiovascular disease ( CVD ) using multivariable linear regression models. We also related BP responses to submaximal exercise to the incidence of hypertension, CVD , and all‐cause mortality using Cox proportional hazards regression models. Each SD increment of exercise BP was associated with higher log‐transformed left ventricular mass (systolic blood pressure [ SBP] , β=0.02, P =<0.001; diastolic blood pressure [ DBP ], β=0.01, P =0.004) and carotid intima‐media thickness (SBP, β=0.08, P =<0.001). Rapid BP recovery (per 1 SD increment) was associated with lower log left ventricular mass ( SBP recovery ; β=−0.03, P =<0.001) and carotid intima‐media thickness ( SBP recovery , β=−0.07, P =0.003; DBP recovery , β=−0.09, P =0.003). Additionally, Each SD increment of exercise BP was associated with a higher risk of incident hypertension ( SBP , hazard ratio [HR], 1.40; 95% CI , 1.20–1.62; DBP , HR, 1.24; 95% CI , 1.11–1.40) and CVD ( DBP, HR, 1.15; 95% CI , 1.02–1.30). Finally, the multivariable‐adjusted HR for each 1‐SD increment of BP recovery was 0.46 ( SBP recovery , 95% CI , 0.38–0.54) and 0.55 ( DBP recovery , 95% CI , 0.45–0.67) for hypertension; 0.80 ( SBP recovery , 95% CI , 0.69–0.93) for CVD ; and 0.76 ( SBP recovery , 95% CI , 0.65–0.88) for all‐cause mortality. Conclusions Higher submaximal exercise BP and impaired BP recovery after submaximal exercise in midlife may be markers of subclinical and clinical CVD and mortality in later life.