ANTICIPATORY BLOOD-PRESSURE RESPONSE TO EXERCISE PREDICTS FUTURE HIGHBLOOD-PRESSURE IN MIDDLE-AGED MEN

Increases in blood pressure during the period of emotional arousal att endant to impending exertion are well documented, yet the etiologic si gnificance of these elevations is unknown. Research suggests that exag gerated cardiovascular responses to psychological stress may be import antly related to hypertension. We examined blood pressure reactivity i n anticipation of an exercise stress test in relation to future hypert ension in the Kuopio Ischemic Heart Disease Risk Factor Study, a popul ation-based study of middle-aged men from Eastern Finland. Subjects we re 508 unmedicated men with resting blood pressure less than 165/95 mm Hg who completed a bicycle ergometer stress test at baseline and whos e hypertensive status was assessed at 4 years of follow-up. Systolic a nd diastolic reactivity were calculated as the difference between bloo d pressure measured after seated rest on the bicycle ergometer before initiation of exercise and mean seated resting blood pressure measured 1 week earlier. Logistic regression models adjusted for age and resti ng blood pressure revealed a graded association between quartiles of r eactivity and risk of subsequent hypertension (greater than or equal t o 165/95 mm Hg), with men showing systolic responses greater than or e qual to 30 mm Hg or diastolic responses greater than 15 mm Hg at nearl y four times the risk of becoming hypertensive (odds ratios, 3.80 [95% confidence interval, 1.90 to 7.63] and 3.65 [95% confidence interval, 1.86 to 7.17], respectively) relative to the least-reactive groups (s ystolic response, <10 mm Hg; diastolic response, <5 mm Hg). Adjustment s for traditional risk factors for hypertension did not alter these as sociations. Results demonstrate the clinical significance of the press er response in anticipation of exercise and support the hypothesis tha t cardiovascular reactivity to psychological challenge plays a role in the etiology of hypertension.