Key result
Anti-hypertensive treatment fails to eliminate exercise hypertension in ~23% of older adults with controlled resting BP.
Why the study?
The effect of pharmacological antihypertensive treatment on exercise blood pressure in older adults, accounting for exercise capacity, is largely unknown.
Does pharmacological antihypertensive treatment mitigate an exaggerated exercise blood pressure response and affect exercise capacity in older adults?
Observational (n=659)
No
Does pharmacological antihypertensive treatment mitigate an exaggerated exercise blood pressure response and affect exercise capacity in older adults?
Absolute Event Rate: 177% vs 180%
p-value: p=0.266
Antihypertensive treatment does not fully mitigate an exaggerated blood pressure response to exercise in older adults and is associated with lower exercise capacity, suggesting residual cardiovascular risk despite resting blood pressure control.
Exercise BP monitoring should not yet alter antihypertensive regimens; leaves open its value as residual risk marker in treated older adults.
BACKGROUND: An exaggerated blood pressure (BP) response to exercise and low exercise capacity are risk factors for cardiovascular disease (CVD). The effect of pharmacological antihypertensive treatment on exercise BP in older adults is largely unknown. This study investigates these effects accounting for differences in exercise capacity. METHODS: Participants enrolled in the Southall and Brent Revisited (SABRE) study undertook a 6-min stepper test with expired gas analysis and BP measured throughout exercise. Participants were stratified by antihypertensive treatment status and resting BP control. Exercise systolic and diastolic BP (exSBP and exDBP) were compared between groups using potential outcome means [95% confidence intervals (CIs)] adjusted for exercise capacity. Exercise capacity was also compared by group. RESULTS: In total, 659 participants were included (mean age ± SD: 73 ± 6.6 years, 57% male). 31% of normotensive and 23% of hypertensive older adults with controlled resting BP had an exaggerated exercise BP. ExSBP was similar between normotensive and treated/controlled individuals [mean (95%CI): 180 (176 184) mmHg vs. 177 (173 181) mmHg, respectively] but was higher in treated/uncontrolled and untreated/uncontrolled individuals [mean (95% CI): 194 (190 197) mmHg, P < 0.001 and 199 (194 204) mmHg, P < 0.001, respectively]; these differences persisted after adjustment for exercise capacity and other confounders. Exercise capacity was lower in treated vs. normotensive individuals [mean (95% CI) normotensive: 16.7 (16.0,17.4) ml/kg/min]; treated/controlled: 15.5 (14.8,16.1) ml/kg/min, P = 0.009; treated/uncontrolled: [15.1 (14.5,15.7) ml/kg per min, P = 0.001] but was not reduced in untreated/uncontrolled individuals [mean (95% CI): 17.0 (16.1,17.8) ml/kg per min, P = 0.621]. CONCLUSION: Irrespective of resting BP control and despite performing less exercise, antihypertensive treatment does not fully mitigate an exaggerated BP response to exercise suggesting residual CVD risk in older adults.
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Jones et al. (2022) conducted an observational in Hypertension (n=659). Anti-hypertensive treatment (treated/controlled) vs. Normotensive (untreated/controlled) was evaluated on Exercise systolic blood pressure (exSBP) (p=0.266). Anti-hypertensive treatment does not fully mitigate an exaggerated blood pressure response to exercise, with 23% of treated older adults with controlled resting blood pressure still exhibiting exercise hypertension.
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