Association of Blood Pressure Responses to Submaximal Exercise in Midlife With the Incidence of Cardiovascular Outcomes and All-Cause Mortality: The Framingham Heart Study
Open accessAbstract
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.
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Exaggerated exercise blood pressure (EEBP) recorded during clinical exercise testing is independently associated with blood pressure-related cardiovascular disease (CVD) outcomes.
“Exaggerated exercise blood pressure recorded during clinical exercise testing is independently associated with blood pressure -related cardiovascular disease outcomes”
From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [8]
The Results section (page unavailable) reports that higher exercise diastolic blood pressure was associated with incident CVD after adjustment for other risk factors; both systolic and diastolic exercise blood pressure were associated with incident hypertension. The claim is broader than these findings: the study analyzed continuous blood-pressure measures during submaximal exercise, not a defined category of exaggerated exercise blood pressure, and it did not report an association between higher exercise systolic pressure and incident CVD. (LLM, conf=0.85)
Experimental — accuracy not yet measuredSubsequent meta-analysis and other longitudinal studies have confirmed the association between submaximal exercise systolic blood pressure and cardiovascular events and death.
“A subsequent meta-analysis (10), and other longitudinal studies (7,8), have since confirmed these results.”
From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [8]
The Results report that systolic blood pressure (SBP) recovery after submaximal exercise was associated with cardiovascular events and all-cause mortality. But the Discussion (Comparison With the Literature) says the study did not find an adjusted association between SBP during submaximal exercise and incident cardiovascular disease. The paper therefore supports the claim for SBP recovery, not for exercise SBP itself. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMore recent longitudinal studies and a further meta-analysis have confirmed the CVD risk associated with EEBP during submaximal exercise.
“More recent longitudinal studies and a further meta-analysis have confirmed the CVD risk associated with EEBP during submaximal exercise [25,26,27].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [27]
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“A subsequent meta-analysis (10), and other longitudinal studies (7,8), have since confirmed these results.”
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- Authors
- Lee, J., Vasan, R. S., & Xanthakis, V.
- Affiliations
- Boston University (US)
- Corresponding author
- Xanthakis, Vanessa
- Venue
- Journal of the American Heart Association
- Published
- 2020-06-02
- Volume
- 9
- Issue
- 11
- Pages
- e015554-e015554
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC7428993
- OpenAlex
- W3027635096
- Cited by
- 35
- References
- 35
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 10 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 1
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (HHSN268201500001I, 75N92019D00031, N01-HC-025195, T32HL125232, R01HL131029)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- blood pressure response to exercise, submaximal exercise, blood pressure recovery, left ventricular mass, carotid intima-media thickness, subclinical cardiovascular disease, hypertension incidence, cardiovascular disease incidence, all-cause mortality, midlife, Framingham Offspring Study, cardiovascular risk prediction, blood pressure-lowering therapy, blood pressure targets
- MeSH terms
- Age Factors, Aged, Blood Pressure, Cause of Death, Cerebrovascular Disorders, Cross-Sectional Studies, Exercise Test, Female, Heart Diseases, Humans, Hypertension, Male, Massachusetts, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Time Factors, Incidence, Risk Assessment, Recovery of Function, Peripheral Arterial Disease
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