Dataset Information

Submaximal exercise blood pressure and cardiovascular structure in adolescence.

ABSTRACT:

Purpose

Dynamic exercise results in increased systolic blood pressure (BP). Irrespective of resting BP, some individuals may experience exaggerated rise in systolic BP with exercise, which in adulthood is associated with risk of hypertension, and cardiovascular (CV) disease. It is unknown if exercise BP is associated with markers of CV structure during adolescence. We examined this question in a large adolescent cohort taking account of the possible confounding effect of body composition and BP status.

Methods

4036 adolescents (mean age 17.8?±?0.4?years, 45% male), part of a UK population-based birth cohort study completed a sub-maximal step-test with BP immediately post-exercise. Sub-samples underwent comprehensive echocardiography for assessment of cardiac structure; arterial structure including aortic pulse wave velocity (PWV) and carotid intima-media thickness; and assessment of body composition by dual-energy X-ray absorptiometry (DXA).

Results

Each 5?mm?Hg higher post-exercise systolic BP was associated with CV structure, including 0.38?g/m^2.7 (95% CI: 0.29, 0.47) greater left-ventricular mass index (LVMI), and 0.04?m/s (95% CI: 0.03, 0.04) greater aortic PWV. Adjustment for age, total body fat, lean mass and BP status attenuated, but did not abolish associations with LVMI (0.14?g/m^2.7 per 5?mm?Hg of post-exercise systolic BP; 95% CI 0.21, 0.39) or aortic PWV (0.03?m/s per 5?mm?Hg of post-exercise systolic BP; 95% CI: 0.02, 0.04).

Conclusion

Submaximal exercise systolic BP is associated with markers of CV structure in adolescents. Given the clinical relevance of exercise BP in adulthood, such associations may have implications for CV disease screening in young people and risk in later life.

SUBMITTER: Schultz MG

PROVIDER: S-EPMC6282652 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Publications

Submaximal exercise blood pressure and cardiovascular structure in adolescence.

Schultz Martin G MG Park Chloe C Fraser Abigail A Howe Laura D LD Jones Siana S Rapala Alicja A Davey Smith George G Sharman James E JE Lawlor Deborah A DA Chaturvedi Nish N Deanfield John J Hughes Alun D AD

International journal of cardiology 20181019

<h4>Purpose</h4>Dynamic exercise results in increased systolic blood pressure (BP). Irrespective of resting BP, some individuals may experience exaggerated rise in systolic BP with exercise, which in adulthood is associated with risk of hypertension, and cardiovascular (CV) disease. It is unknown if exercise BP is associated with markers of CV structure during adolescence. We examined this question in a large adolescent cohort taking account of the possible confounding effect of body composition ...[more]

PMID: 30509371

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Project description:PURPOSE:Exaggerated exercise blood pressure (BP) is associated with altered cardiac structure and increased cardiovascular risk. Fitness modifies these associations, but the effect in healthy adolescents is unknown. We performed an observational study to determine the influence of fitness on post-exercise BP, and on its relationship with cardiac structure in adolescents. METHODS:4835 adolescents from the Avon Longitudinal Study of Parents and Children, (15.4 (0.3) years, 49% male) completed a submaximal cycle test. Fitness was estimated as physical work capacity 170 adjusted for lean body mass and post-exercise BP measured immediately posttest. Cardiovascular structure and function, including left ventricular (LV) mass (n = 1589), left atrium (LA) size (n = 1466), cardiac output (CO, n = 1610), and total peripheral resistance (TPR, n = 1610) were measured at rest by echocardiography 2.4 (0.4) years later. RESULTS:Post-exercise systolic BP increased stepwise by fitness tertile (131.2 mm Hg [130.4, 132.1]; 137.3 mm Hg [136.5, 138.0]; 142.3 mm Hg [141.5, 143.1]). Each 5 mm Hg of post-exercise systolic BP was associated with 2.46 g [1.91, 3.01] greater LV mass, 0.02 cm [0.02, 0.03] greater LA size, and 0.25 g/m2.7 [0.14, 0.36] greater LV mass index. Adjustment for fitness abolished associations (0.29 g [-0.16, 0.74]; 0.01 cm [-0.001, 0.014] and 0.08 g/m2.7 [-0.001, 0.002]). Similar associations between post-exercise systolic BP and each outcome were found between the lowest and highest fitness thirds. CO increased with fitness third (difference 0.06 L/min [-0.05, 0.17]; 0.23 L/min [0.12, 0.34]) while TPR decreased (difference -0.13 mm Hg·min/L [-0.84,0.59]; -1.08 mm Hg·min/L [-0.1.80, 0.35]). CONCLUSIONS:Post-exercise systolic BP increased with fitness, which modified its association with cardiac structure. Higher CO, but lower TPR suggests a physiologically adapted cardiovascular system with greater fitness, highlighting the importance of fitness in adolescence.

Project description:Dynamic exercise results in an increase to systolic blood pressure (BP). Irrespective of resting BP, some individuals may experience an exaggerated rise in systolic BP with exercise, which in adulthood, is associated with greater risk of developing hypertension, cardiovascular morbidity and mortality. It is not known if exercise BP is associated with adverse cardiovascular risk during adolescence. We determined associations of exercise BP with left ventricular mass (LVM) in adolescents, with consideration of the possible confounding effect of body composition.We undertook a cross-sectional study of 3,949 adolescents (mean age 17.8 ± 0.4 years, 45% male) who were part of a UK population-based birth cohort study. A sub-maximal exercise step-test with automated BP measurement immediately post-exercise was completed and body composition (total fat and lean mass) assessed by dual-energy x-ray absorptiometry. A sub-sample (n = 1,241) underwent comprehensive echocardiographic assessment.Each 5 mmHg increase in post-exercise systolic BP was associated with 0.34 g/m2.7 (95% CI: 0.24, 0.45) greater LVM indexed to height2.7 with adjustment for age, sex and hypertension status (p < 0.001). Further adjustment for lean mass attenuated this association to 0.29 g/m2.7 (95% CI 0.19, 0.39; p < 0.001) for each 5 mmHg of post-exercise systolic BP, adjustment for fat mass attenuated it to 0.15 g/m2.7 (95% CI 0.05, 0.25; p = 0.003), and adjustment for both lean and fat mass attenuated it to 0.13 g/m2.7 (95% CI 0.03, 0.23; p = 0.012). Individuals with post-exercise systolic BP ≥150 mmHg (corresponding to post-exercise systolic BP >70th percentile) had a 7% greater LVM compared to those with post-exercise systolic BP < 150 mmHg (p < 0.001).Exaggerated exercise systolic BP is associated with higher LVM, adjustment for body composition attenuates but does not abolish this association. These results may have important implications for cardiovascular risk in later life.

Dataset Information

Submaximal exercise blood pressure and cardiovascular structure in adolescence.

Purpose

Methods

Results

Conclusion

Publications

Submaximal exercise blood pressure and cardiovascular structure in adolescence.

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