Association of exercise blood pressure response with subclinical abnormalities of cardiac remodeling and function in middle-aged women

Hypertension is the most common risk factor in women and confers the highest risk for developing heart failure among women. Hypertensive response to exercise (HRE) is observed in individuals with normal resting blood pressure (BP). An excessive elevation of systolic BP (SBP) during exercise has been independently associated with future hypertension and the development of heart failure. However, limited evidence exists on the associations of exercise SBP response and subclinical abnormalities of cardiac remodeling and function in women.

We examined the association between the SBP response to exercise and parameters of subclinical cardiac remodeling and function in middle-aged women.

150 normotensive women with abdominal adiposity (waist circumference >80 cm) and without cardiac condition were recruited. None were treated for BP. Anthropometric, metabolic and echocardiographic data were collected. Exercise BP was assessed during a maximal exercise treadmill test. All exercising BP measurements were collected manually using standard auscultatory methods according to current guidelines. HRE was defined as ≥90th percentile from age- and sex-specific normative data. Standard echocardiography and speckle tracking echocardiography were obtained.

A total of 126 women (66% menopausal) aged 54 ± 11 years and pre-test resting SBP of 114 ± 9 mmHg were included. Women with HRE (n=30, 24% of women) had similar age and BMI compared to women without HRE (p>0.05). Waist-to-hip ratio and resting SBP (118±8 vs 112±9 mmHg) were higher in the HRE group (p<0.05). Exercise duration and metabolic equivalents were comparable between women with or without HRE (p>0.05). Abnormalities of cardiac remodeling (increased left ventricular (LV) wall thickness and LV mass) were found in women with HRE (p<0.01). No difference was between groups observed for parameters of diastolic function (mitral velocities and the E/A ratio, left atrial dimension, and the E/E' ratio) and systolic function (LV global longitudinal strain) after adjustment for age (all p>0.05). In univariate analyses (all women), maximal SBP was significantly associated with pre-test resting SBP, LV wall thickness, and LV mass, all p<0.01). In multivariate analyses, maximum exercise SBP remained independently associated with cardiac remodeling indices (p<0.01).

Normotensive women with abdominal obesity and exaggerated exercise BP response are more likely to have adverse cardiac remodeling, which may predispose toward the development of heart failure. An excessive exercise BP in women may be an inexpensive screening tool to identify women at highest risk for developing future hypertension and heart failure.