Association of Blood Pressure Responses to Submaximal Exercise in Midlife With the Incidence of Cardiovascular Outcomes and All‐Cause Mortality: The Framingham Heart Study

BACKGROUND: Few studies examined the associations of midlife blood pressure (BP) responses to submaximal exercise with the risk of cardiovascular outcomes and mortality in later life. METHODS AND RESULTS: We evaluated 1993 Framingham Offspring Study participants (mean age, 58 years; 53.2% women) attending examination cycle 7. We related BP responses to submaximal exercise with prevalent subclinical cardiovascular disease (CVD) using multivariable linear regression models. We also related BP responses to submaximal exercise to the incidence of hypertension, CVD, and all‐cause mortality using Cox proportional hazards regression models. Each SD increment of exercise BP was associated with higher log‐transformed left ventricular mass (systolic blood pressure [SBP], β=0.02, P=<0.001; diastolic blood pressure [DBP], β=0.01, P=0.004) and carotid intima‐media thickness (SBP, β=0.08, P=<0.001). Rapid BP recovery (per 1 SD increment) was associated with lower log left ventricular mass (SBP (recovery); β=−0.03, P=<0.001) and carotid intima‐media thickness (SBP (recovery), β=−0.07, P=0.003; DBP (recovery), β=−0.09, P=0.003). Additionally, Each SD increment of exercise BP was associated with a higher risk of incident hypertension (SBP, hazard ratio [HR], 1.40; 95% CI, 1.20–1.62; DBP, HR, 1.24; 95% CI, 1.11–1.40) and CVD (DBP, HR, 1.15; 95% CI, 1.02–1.30). Finally, the multivariable‐adjusted HR for each 1‐SD increment of BP recovery was 0.46 (SBP (recovery), 95% CI, 0.38–0.54) and 0.55 (DBP (recovery), 95% CI, 0.45–0.67) for hypertension; 0.80 (SBP (recovery), 95% CI, 0.69–0.93) for CVD; and 0.76 (SBP (recovery), 95% CI, 0.65–0.88) for all‐cause mortality. CONCLUSIONS: Higher submaximal exercise BP and impaired BP recovery after submaximal exercise in midlife may be markers of subclinical and clinical CVD and mortality in later life.