Association of blood pressure and heart rate responses to submaximal exercise with incident heart failure: The framingham heart study

Herman A. Carneiro, Rebecca J. Song, Joowon Lee, Brian Schwartz, Ramachandran S. Vasan, Vanessa Xanthakis

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND: Exercise stress tests are conventionally performed to assess risk of coronary artery disease. Using the FHS (Framingham Heart Study) Offspring cohort, we related blood pressure (BP) and heart rate responses during and after sub-maximal exercise to the incidence of heart failure (HF). METHODS AND RESULTS: We evaluated Framingham Offspring Study participants (n=2066; mean age, 58 years; 53% women) who completed 2 stages of an exercise test (Bruce protocol) at their seventh examination (1998– 2002). We measured pulse pressure, systolic BP, diastolic BP, and heart rate responses during stage 2 exercise (2.5 mph at 12% grade). We calculated the changes in systolic BP, diastolic BP, and heart rate from stage 2 to recovery 3 minutes after exercise. We used Cox proportional hazards regression to relate each standardized exercise variable (during stage 2, and at 3 minutes of recovery) individually to HF incidence, adjusting for standard risk factors. On follow-up (median, 16.8 years), 85 participants developed new-onset HF. Higher exercise diastolic BP was associated with higher HF with reduced ejection fraction (ejection fraction <50%) risk (hazard ratio [HR] per SD increment, 1.26; 95% CI, 1.01–1.59). Lower stage 2 pulse pressure and rapid postexercise recovery of heart rate and systolic BP were associated with higher HF with reduced ejection fraction risk (HR per SD incre-ment, 0.73 [95% CI, 0.57– 0.94]; 0.52 [95% CI, 0.35– 0.76]; and 0.63 [95% CI, 0.47– 0.84], respectively). BP and heart rate responses to submaximal exercise were not associated with risk of HF with preserved ejection fraction (ejection fraction ≥50%). CONCLUSIONS: Accentuated diastolic BP during exercise with slower systolic BP and heart rate recovery after exercise are markers of HF with reduced ejection fraction risk.

Original languageEnglish (US)
Article numbere019460
JournalJournal of the American Heart Association
Volume10
Issue number7
DOIs
StatePublished - Apr 6 2021
Externally publishedYes

Keywords

  • Exercise
  • Heart failure
  • Hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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