Blood pressure response during treadmill testing as a risk factor for new-onset hypertension - The Framingham Heart Study

Background-Although systolic blood pressure (SBP) response to exercise has been shown to predict subsequent hypertension in small samples of men, this association has not been studied in a large population-based sample of mid dle-aged men and women. The purpose of this study was to examine, in normot ensive subjects, the relations of SEP and diastolic blood pressure (DBP) du ring the exercise and recovery periods of a graded treadmill test to the ri sk of developing new-onset hypertension. Methods and Results-BP data from exercise testing in 1026 men and 1284 wome n (mean age, 42+/-10 years; range, 20 to 69 years) from the Framingham Offs pring Study who were normotensive at baseline were related to the incidence of hypertension 8 years later. New-onset hypertension, defined as an SEP g reater than or equal to 140 mm Hg or DBP greater than or equal to 90 mm Hg or the initiation of antihypertensive drug treatment, occurred in 228 men ( 22%) and 207 women (16%). Exaggerated SEP (Ex-SBP 2) and DBP (Ex-DBP 2) res ponse and delayed recovery of SEP (R-SBP 3) and DBP (R-DBP 3) were defined as an age-adjusted BP greater than the 95th percentile during the second st age of exercise and third minute of recovery, respectively. After multivari able adjustment, Ex-DBP 2 was highly predictive of incident hypertension in both men (OR, 4.16; 95% CI, 2.15, 8.05) and women (OR, 2.17; CI, 1.19, 3.9 6). R-SBP 3 was predictive of hypertension in men in a multivariable model that included exercise duration and peak exercise BP (OR, 1.92; CI, 1.00, 3 .69). Baseline resting SEP (chi(2), 23.4 in men and 34.7 in women) and DBP (chi(2), 11.3 in men and 13.1 in women) had stronger associations with new- onset hypertension than exercise DBP (chi(2), 16.4 in men and 6.1 in women) and recovery SEP (chi(2), 6.5 in men and 2.1 in women) responses. Conclusions-An exaggerated DBP response to exercise was predictive of risk for new-onset hypertension in normotensive men and women. An elevated recov ery SEP was predictive of hypertension in men. These findings may reflect s ubtle pathophysiological features in the preclinical stage of hypertension.