Exercise Blood Pressure and the Risk for Future Hypertension Among Normotensive Middle-Aged Adults

Background-The aim of the present study was to examine whether exercise blood pressure can be used to predict the development of hypertension in normotensive middle-aged adults. Methods and Results-We investigated 7082 normotensive subjects who were annually screened in a tertiary medical center and completed maximal treadmill exercise tests at each visit. After the initial 3 years, subjects were divided into approximate quartiles according to their average exercise systolic and diastolic blood pressure responses (<= 158; 158 to 170; 170 to 183; >= 183 mm Hg for systolic blood pressure and <= 73; 73 to 77; 77 to 82; >= 82 mm Hg for diastolic blood pressure). Mean age of the study population was 48 +/- 9 years and 73% were men. Average baseline resting blood pressure was 120/77 +/- 12/7 mm Hg. During a follow-up of 5 +/- 3 years, 1036 (14.6%) subjects developed hypertension. The cumulative probability of new-onset hypertension at 5 years was significantly increased with increasing quartiles of exercise systolic blood pressure (5%, 9%, 17%, and 35%, respectively; P<0.001), with a similar association shown for diastolic blood pressure. After adjustment for baseline resting blood pressure and clinical parameters, each 5-mm Hg increments in exercise either systolic or diastolic blood pressures were independently associated with respective 11% (P<0.001) and 30% (P<0.001) increased risk for the development of hypertension. Conclusions-In normotensive middle-aged individuals, blood pressure response to exercise is associated with future development of hypertension.