Is There a Relationship between Exercise Systolic Blood Pressure Response and Left Ventricular Mass?: The Framingham Heart Study
Abstract
OBJECTIVE: To assess the association between an exaggerated exercise systolic blood pressure response and the occurrence of left ventricular hypertrophy in healthy, normotensive individuals. DESIGN: Cross-sectional survey using M-mode echocardiography to measure left ventricular mass and to detect left ventricular hypertrophy. SETTING: The Framingham Heart Study. SUBJECTS: Eight-hundred sixty men and 1118 women were studied who were free of cardiovascular or pulmonary disease, who were not taking any antihypertensive or cardiovascular medications, and who successfully achieved at least 90% of their age-predicted maximum heart rate during a monitored exercise treadmill test. All subjects had normal baseline and exercise electrocardiograms. MEASUREMENTS AND MAIN RESULTS: Men with a peak exercise systolic blood pressure of 210 or more and women with a peak exercise systolic blood pressure of 190 or more were considered to have an "exaggerated" blood pressure response; 122 men and 67 women met these criteria. Subjects with an exaggerated exercise systolic blood pressure response had 10% higher left ventricular mass than those with a normal exercise systolic blood pressure response (in men: 115 +/- 25 compared with 105 +/- 24 g/m, P less than 0.001; in women: 86 +/- 22 compared with 73 +/- 16 g/m, P less than 0.001); they also had a higher prevalence of left ventricular hypertrophy (in men: odds ratio, 1.34, 95% CI, 1.00 to 1.80; in women: odds ratio, 2.12, CI, 1.48 to 3.03). After adjusting for age, resting systolic blood pressure, and body mass index, however, subjects with an exaggerated exercise systolic blood pressure response had only 5% higher left ventricular mass (in men: 111 +/- 2.1 compared with 106 +/- 0.8 g/m, P = 0.02; in women: 80 +/- 1.8 compared with 74 +/- 0.4 g/m, P = 0.002), and they no longer had a statistically increased prevalence of left ventricular hypertrophy (in men: odds ratio, 1.21, CI, 0.87 to 1.67; in women: odds ratio, 1.30, CI, 0.84 to 2.01). CONCLUSIONS: The apparent relation between exercise systolic blood pressure response and left ventricular mass is confounded by age, resting systolic blood pressure, and body mass; the degree of confounding is such that the biologic significance of this relationship should be questioned.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Traditional thresholds for EEBP are based on exceeding 90th centile BP responses to maximal or peak intensity exercise, commonly ≥210/100 mmHg for males and ≥190/100 mmHg for females.
“Thresholds to denote EEBP have traditionally been set based on exceeding 90th centile BP responses to maximal or peak intensity exercise, and commonly exercise BP values ≥ 210/100 mmHg for males and ≥190/100 mmHg for females [16].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [16]
Cites
Sahn, D. J., DeMaria, A. N., KISSLO, J. A., & Weyman, A. E. (1978) · Circulation · doi:10.1161/01.cir.58.6.1072 · Cited by 7,430 · see citing works
Levy, D., Garrison, R. J., Savage, D. D., Kannel, W. B., & Castelli, W. P. (1990) · New England Journal of Medicine · doi:10.1056/nejm199005313222203 · Cited by 5,699 · see citing works
Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method.
Devereux, R. B., & Reichek, N. (1977) · Circulation · doi:10.1161/01.cir.55.4.613 · Cited by 4,499 · see citing works
Epidemiological approaches to heart disease: the Framingham study
Dawber, T. R., Meadors, G. F., & Moore, F. E. (1951) · American Journal of Public Health and the Nations Health · doi:10.2105/ajph.41.3.279 · Cited by 2,148 · see citing works
Bruce, R. A., Kusumi, F., & Hosmer, D. W. (1973) · American Heart Journal · doi:10.1016/0002-8703(73)90502-4 · Cited by 2,057 · see citing works
AN INVESTIGATION OF CORONARY HEART DISEASE IN FAMILIES
Kannel, W. B., Feinleib, M., McNAMARA, P. M., Garrison, R. J., & Castelli, W. P. (1979) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112813 · Cited by 1,635 · see citing works
Echocardiographically Detected Left Ventricular Hypertrophy: Prevalence and Risk Factors
Levy, D. A., Anderson, K. M., SAVAGE, D. D., Kannel, W. B., Christiansen, J. C., & Castelli, W. P. (1988) · Annals of Internal Medicine · doi:10.7326/0003-4819-108-1-7 · Cited by 812 · see citing works
Self-citationEchocardiographic criteria for left ventricular hypertrophy: The Framingham heart study
Levy, D. A., Savage, D. D., Garrison, R. J., Anderson, K. M., Kannel, W. B., & Castelli, W. P. (1987) · The American Journal of Cardiology · doi:10.1016/0002-9149(87)91133-7 · Cited by 798 · see citing works
Self-citationLeft Ventricular Mass and Incidence of Coronary Heart Disease in an Elderly Cohort
Levy, D. A., Garrison, R. J., Savage, D. D., Kannel, W. B., & Castelli, W. P. (1989) · Annals of Internal Medicine · doi:10.7326/0003-4819-110-2-101 · Cited by 700 · see citing works
Self-citationHeart Disease: A Textbook of Cardiovascular Medicine
Jones, R. J. (1988) · JAMA · doi:10.1001/jama.1988.03410180146053 · Cited by 614 · see citing works
AN APPROACH TO LONGITUDINAL STUDIES IN A COMMUNITY: THE FRAMINGHAM STUDY
Dawber, T. R., Kannel, W. B., & Lyell, L. P. (1963) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1963.tb13299.x · Cited by 561 · see citing works
Hammond, I. W., Devereux, R. B., Alderman, M. H., Lutas, E. M., Spitzer, M. C., Crowley, J. S., & Laragh, J. H. (1986) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(86)80476-4 · Cited by 421 · see citing works
Echocardiographic assessment of cardiac anatomy and function in hypertensive subjects.
Savage, D. D., Drayer, J. I. M., Henry, W. L., Mathews, E. C., Ware, J. H., Gardin, J. M., Cohen, E., Epstein, S. E., & Laragh, J. H. (1979) · Circulation · doi:10.1161/01.cir.59.4.623 · Cited by 365 · see citing works
MacMahon, S. W., Wilcken, D., & Macdonald, G. (1986) · New England Journal of Medicine · doi:10.1056/nejm198602063140602 · Cited by 362 · see citing works
Gottdiener, J. S., Brown, J., Zoltick, J., & Fletcher, R. D. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-112-3-161 · Cited by 224 · see citing works
Follow-up of normotensive men with exaggerated blood pressure response to exercise
Dlin, R. A., Hanne-Paparo, N., Silverberg, D. S., & Bar‐Or, O. (1983) · American Heart Journal · doi:10.1016/0002-8703(83)90198-9 · Cited by 205 · see citing works
Savage, D. D., Levy, D. A., Dannenberg, A. L., Garrison, R. J., & Castelli, W. P. (1990) · The American Journal of Cardiology · doi:10.1016/0002-9149(90)90304-j · Cited by 195 · see citing works
Self-citationDannenberg, A. L., Levy, D. A., & Garrison, R. J. (1989) · The American Journal of Cardiology · doi:10.1016/0002-9149(89)90816-3 · Cited by 194 · see citing works
Self-citationGordon, T., Moore, F. E., Shurtleff, D., & Dawber, T. R. (1959) · Journal of Chronic Diseases · doi:10.1016/0021-9681(59)90002-5 · Cited by 177 · see citing works
Early prediction of hypertension using exercise blood pressure
Wilson, N. V., & Meyer, B. M. (1981) · Preventive Medicine · doi:10.1016/0091-7435(81)90006-2 · Cited by 163 · see citing works
Left ventricular structure and function by echocardiography in ultraendurance athletes
Douglas, P. S., OʼToole, M. L., Hiller, W. D. B., & Reichek, N. (1986) · The American Journal of Cardiology · doi:10.1016/0002-9149(86)90358-9 · Cited by 145 · see citing works
Ren, J., Hakki, A., Kotler, M. N., & Iskandrian, A. S. (1985) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(85)80029-2 · Cited by 137 · see citing works
Prognostic significance of exercise versus resting blood pressure in hypertensive men.
Fagard, R. H., Staessen, J. A., Thijs, L., & Amery, A. (1991) · Hypertension · doi:10.1161/01.hyp.17.4.574 · Cited by 101 · see citing works
Considerations in the use of echocardiography in epidemiology. The Framingham Study.
Savage, D. D., Garrison, R. J., Kannel, W. B., Anderson, S. J., Feinleib, M., & Castelli, W. P. (1987) · Hypertension · doi:10.1161/01.hyp.9.2_pt_2.ii40 · Cited by 78 · see citing works
HYPERTENSION, BLOOD LIPIDS, AND CIGARETTE SMOKING AS CO‐RISK FACTORS FOR CORONARY HEART DISEASE
Kannel, W. B. (1978) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1978.tb25585.x · Cited by 68 · see citing works
Does Increased Blood Pressure Cause Left Ventricular Hypertrophy or Vice Versa?
Devereux, R. B. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-112-3-157 · Cited by 44 · see citing works
Vandenbossche, J.-L., Kramer, B. L., Massie, B. M., et al. (1984) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(84)80138-2 · Cited by 28 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Schultz, M. G., Otahal, P., Cleland, V. J., Blizzard, L., Marwick, T. H., & Sharman, J. E. (2013) · American Journal of Hypertension · doi:10.1093/ajh/hps053 · Cited by 306 · see citing works
The blood pressure response to dynamic exercise testing: A systematic review
Le, V.-V., Mitiku, T., Sungar, G., Myers, J., & Froelicher, V. (2008) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2008.07.001 · Cited by 197 · see citing works
Exercise blood pressure: Clinical relevance and correct measurement
Sharman, J. E., & LaGerche, A. (2015) · Journal of Human Hypertension · doi:10.1038/jhh.2014.84 · Cited by 142 · see citing works
Lauer, M. S., Pashkow, F. J., Harvey, S. A., Marwick, T. H., & Thomas, J. D. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)00388-6 · Cited by 127 · see citing works
Self-citationKokkinos, P., Pittaras, A., Narayan, P., Faselis, C., Singh, S., & Manolis, A. (2007) · Hypertension · doi:10.1161/01.hyp.0000250759.71323.8b · Cited by 111 · see citing works
Sharman, J. E., Hare, J. L., Thomas, S., Davies, J. E., Leano, R., Jenkins, C., & Marwick, T. H. (2011) · American Journal of Hypertension · doi:10.1038/ajh.2011.75 · Cited by 108 · see citing works
Mottram, P. M., Haluska, B., Yuda, S., Leano, R., & Marwick, T. H. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.08.057 · Cited by 85 · see citing works
Scott, J. A., Coombes, J. S., Prins, J. B., Leano, R. L., Marwick, T. H., & Sharman, J. E. (2008) · American Journal of Hypertension · doi:10.1038/ajh.2008.166 · Cited by 82 · see citing works
Keller, K., Stelzer, K., Ostad, M. A., & Post, F. (2017) · Advances in Medical Sciences · doi:10.1016/j.advms.2016.11.010 · Cited by 72 · see citing works
Exaggerated blood pressure response to exercise—A new portent of masked hypertension
Kayrak, M., Bacaksiz, A., Vatankulu, M. A., Ayhan, S. S., Kaya, Z., Ari, H., Sonmez, O., & Gok, H. (2010) · Clinical and Experimental Hypertension · doi:10.3109/10641963.2010.503298 · Cited by 67 · see citing works
Schultz, M. G., Picone, D. S., Nikolic, S. B., Williams, A. D., & Sharman, J. E. (2016) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2016.04.004 · Cited by 58 · see citing works
Mariampillai, J. E., Liestøl, K., Kjeldsen, S. E., Prestgaard, E. E., Engeseth, K., Bodegard, J., Berge, E., Gjesdal, K., Erikssen, J., Grundvold, I., et al. (2020) · Hypertension · doi:10.1161/hypertensionaha.119.13528 · Cited by 45 · see citing works
Zafrir, B., Aker, A., Asaf, Y., & Saliba, W. (2022) · Journal of Hypertension · doi:10.1097/hjh.0000000000002991 · Cited by 42 · see citing works
Lee, J., Vasan, R. S., & Xanthakis, V. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.119.015554 · Cited by 35 · see citing works
Sarma, S., Howden, E., Carrick-Ranson, G., Lawley, J., Hearon, C., Samels, M., Everding, B., Livingston, S., Adams-Huet, B., Palmer, M. D., et al. (2020) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00458.2019 · Cited by 26 · see citing works
Schultz, M. G., Currie, K. D., Hedman, K., Climie, R. E., Maiorana, A., Coombes, J. S., & Sharman, J. E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19052819 · Cited by 27 · see citing works
Lorbeer, R., Ittermann, T., Völzke, H., Gläser, S., Ewert, R., Felix, S. B., & Dörr, M. (2015) · Journal of Hypertension · doi:10.1097/hjh.0000000000000568 · Cited by 24 · see citing works
Mariampillai, J. E., Engeseth, K., Kjeldsen, S. E., Grundvold, I., Liestøl, K., Erikssen, G., Erikssen, J., Bodegard, J., & Skretteberg, P. T. (2017) · Blood Pressure · doi:10.1080/08037051.2017.1291276 · Cited by 24 · see citing works
Hare, J. L., Sharman, J. E., Leano, R., Jenkins, C., Wright, L., & Marwick, T. H. (2013) · American Journal of Hypertension · doi:10.1093/ajh/hpt008 · Cited by 20 · see citing works
Huang, Z., Fonseca, R., Sharman, J. E., Park, C., Chaturvedi, N., Howe, L. D., Hughes, A. D., & Schultz, M. G. (2020) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.13645 · Cited by 13 · see citing works
- Authors
- Lauer, M. S., Levy, D., Anderson, K. M., & Plehn, J. F.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1992-02-01
- Volume
- 116
- Issue
- 3
- Pages
- 203-210
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2073209132
- Cited by
- 212
- References
- 27
- Citations by year
- 2026: 4 · 2025: 16 · 2024: 12 · 2023: 4 · 2022: 9 · 2021: 9 · 2020: 7 · 2019: 4 · 2018: 8 · 2017: 10 · 2016: 13 · 2015: 10 · 2014: 7 · 2013: 11 · 2012: 5
- FWCI
- 2.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc038038-022, 5t32hl007374-41)
- National Heart, Lung, and Blood Institute (N01-HC-38038, HL07374)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- left ventricular hypertrophy, left ventricular mass, blood pressure response to exercise, normotensive subjects, sex differences, cardiovascular risk factors, Framingham Heart Study, treadmill exercise testing, M-mode echocardiography, body mass index, resting systolic blood pressure, cardiovascular risk stratification, hypertension prevention, cardiovascular disease prevention
- MeSH terms
- Adult, Analysis of Variance, Blood Pressure, Body Surface Area, Echocardiography, Electrocardiography, Exercise Test, Physical Exertion, Female, Cardiomegaly, Heart Ventricles, Humans, Male, Middle Aged, Prospective Studies, Prevalence, Multivariate Analysis, Confidence Intervals, Odds Ratio, Ventricular Function
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
