Exercise blood pressure, cardiorespiratory fitness and mortality risk

Peter Kokkinos; Charles Faselis; Labros Sidossis; Jiajia Zhang; Immanuel Babu Henry Samuel; Ali Ahmed; Pamela Karasik; Andreas Pittaras; Michael Doumas; Charalabos Grassos; Shirit Rosenberg; Jonathan Myers

doi:10.1016/j.pcad.2021.01.003

Exercise blood pressure, cardiorespiratory fitness and mortality risk

Prog Cardiovasc Dis. 2021 Jul-Aug:67:11-17. doi: 10.1016/j.pcad.2021.01.003. Epub 2021 Jan 26.

Authors

Affiliations

¹ Veterans Affairs Medical Center, Washington DC, USA; Rutgers University Department of Kinesiology and Health, New Brunswick, NJ, USA; George Washington University School of Medicine and Health Sciences, Washington DC, USA.
² Veterans Affairs Medical Center, Washington DC, USA; George Washington University School of Medicine and Health Sciences, Washington DC, USA.
³ Rutgers University Department of Kinesiology and Health, New Brunswick, NJ, USA.
⁴ University of South Carolina, Department of Epidemiology and Biostatistics, USA.
⁵ War Related Illness and Injury Study Center, Washington DC, USA; Henry M. Jackson Foundation for the Advancement Military Medicine, MD, USA.
⁶ George Washington University School of Medicine and Health Sciences, Washington DC, USA.
⁷ General Hospital of Attica Hypertension Unit, Athens, Greece.
⁸ VA Palo Alto Health Care System, Cardiology, Palo Alto, CA, USA.
⁹ VA Palo Alto Health Care System, Cardiology, Palo Alto, CA, USA; Stanford University, Cardiology, CA, USA.

PMID: 33513410
DOI: 10.1016/j.pcad.2021.01.003

Abstract

Objective: To assess the cardiorespiratory fitness (CRF) impact on the association between exercise blood pressure (BP) and mortality risk.

Patients and methods: We assessed CRF in 15,004 US Veterans (mean age 57.5 ± 11.2 years) who completed a standardized treadmill test between January 1, 1988 and July 28, 2017 and had no evidence of ischemia. They were classified as Unfit or Fit according to the age-specific metabolic equivalents (METs) achieved <50% (6.2 ± 1.6 METs; n = 8440) or ≥ 50% (10.5 ± 2.4 METs; n = 6264). To account for the impact of resting systolic BP (SBP) on outcomes, we calculated the difference (Peak SBP-Resting SBP) and termed it SBP-Reserve. We noted a significant increase in mortality associated with SBP-Reserve ≤52 mmHg and stratified the cohort accordingly (SBP-Reserve ≤52 mmHg and > 52 mmHg). We applied multivariable Cox models to estimate hazard ratios (HR) and 95% confidence interval (CIs) for outcomes.

Results: Mortality risk was significantly elevated only in Unfit individuals with SBP-Reserve ≤52 mmHg compared to those with SBP-Reserve >52 mmHg (HR = 1.35; CI: 1.24-1.46; P < 0.001). We then assessed the CRF and SBP-Reserve interaction on mortality risk with Fit individuals with SBP-Reserve >52 mmHg serving as the referent. Mortality risk was 92% higher (HR = 1.92%; 95% CI: 1.77-2.09; P < 0.001) in Unfit individuals with SBP-Reserve ≤52 mmHg and 47% higher (HR = 1.47; 95% CI: 1.33-1.62; P < 0.001) in those with SBP-Reserve >52 mmHg.

Conclusion: Low CRF was associated with increased mortality risk regardless of peak exercise SBP. The risk was substantially higher in individuals unable to augment their exercise SBP >52 mmHg beyond resting levels.

Keywords: Blood pressure; Cardiorespiratory fitness; Exercise; Hypertension.

MeSH terms

Aged
Blood Pressure*
Cardiorespiratory Fitness*
Cardiovascular Diseases / diagnosis
Cardiovascular Diseases / mortality
Cardiovascular Diseases / prevention & control*
Cause of Death
Exercise Test
Exercise*
Female
Health Status
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Protective Factors
Risk Assessment
Risk Factors
United States / epidemiology
Veterans Health