Abnormal exercise blood pressure predicts left ventricular mass in pre-hypertensive, middle-aged men and women

An abnormal rise in systolic blood pressure (SBP) during exercise is associated with left ventricular hypertrophy (LVH). However, this association and the magnitute of change in exercise SBP is not defined in pre-hypertensives. We assessed cardiac structure (echocardiography) and exercise parameters (BP) in middle-aged pre-hypertrensive men (n=296; age=49±10) and women (n=243; age=54±10yrs) free from heart disease, to determine the association between left venricular structure and exercise BP. LVH was defined as LVM Index≥116g/m2 for men and ≥105g/m2 for women. The prevalence of LVH was 53% in pre-hypertensive women and 21% in men. Significant correlations were noted between LVMI and exercise capacity. Multiple regression analysis (stepwise) revealed that SBP at 6 min of exercise (7METs), age and exercise capacity were the strongest predictors of LVMI for pre-hypertensive men (R2=0.52) and women (R2=0.53). Cut-off analysis revealed that the 6-min SBP threshold for LVH was ≥164 mmHg for men and ≥169 mmHg for women. LVH was present in about 86% of women and 59% of men who reached their respective BP threshold. There was approximately a 6-fold increase in the likelihoood of having LVH in men and 2.9-fold increase in women for every 10 mmHg increase in SBP above these thresholds. Significantly higher LVMI values were also noted in those who met or exceeded the respective SBP threshold vs those who did not (120±23g/m2 vs 92±11g/m2 p=0.000) for men and (133±25g/m2 vs 96±15g/m2; p=0.000) for women respectively. 1) The prevalence of LVH is 2.5 times higher in pre-hypertensive women than men. 2) SBP at 6 min of exercise, predicts LVH in pre-hypertensive men and women. 3) The SBP threshold for LVH is ≥169 mmHg for women and ≥164 mmHg for men. 4) The likelihood of having LVH increases by 6-fold for every 10 mmHg increase above this threshold for men and 2.9-fold for women.