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01-11-2013 | Original Article

Blunted heart rate recovery is associated with exaggerated blood pressure response during exercise testing

Authors: Umuttan Dogan, Mehmet Akif Duzenli, Kurtulus Ozdemir, Hasan Gok

Published in: Heart and Vessels | Issue 6/2013

Abstract

Increased sympathetic activity and endothelial dysfunction are the proposed mechanisms underlying exaggerated blood pressure response to exercise (EBPR). However, data regarding heart rate behavior in patients with EBPR are lacking. We hypothesized that heart rate recovery (HRR) could be impaired in patients with EBPR. A total of 75 normotensive subjects who were referred for exercise treadmill test examination and experienced EBPR were included to this cross-sectional case–control study. The control group consisted of 75 age- and gender-matched normotensive subjects without EBPR. EBPR was defined as a peak exercise systolic blood pressure (BP) ≥210 mmHg in men and ≥190 mmHg in women. HRR was defined as the difference in HR from peak exercise to 1 min in recovery; abnormal HRR was defined as ≤12 beats/min. These parameters were compared with respect to occurrence of EBPR. Mean values of systolic and diastolic BP at baseline, peak exercise, and the first minute of the recovery were significantly higher in the subjects with EBPR. Mean HRR values were significantly lower (P < 0.001) in subjects with EBPR when compared with those without. Pearson’s correlation analysis revealed a significant positive correlation between the decrease in systolic BP during the recovery and degree of HRR in individuals without EBPR (r = 0.42, P < 0.001). Such a correlation was not observed in subjects with EBPR (r = 0.11, P = 0.34). The percentage of abnormal HRR indicating impaired parasympathetic reactivation was higher in subjects with EBPR (29 % vs 13 %, P = 0.02). In logistic regression analyses, HRR and resting systolic BP were the only determinants associated with the occurrence of EBPR (P = 0.001 and P < 0.001, respectively). Decreased HRR was observed in normotensive individuals with EBPR. In subjects with normal BP response to exercise, a linear correlation existed between the degree of HRR and decrease in systolic BP during the recovery period. However, such a correlation was not found in subjects with EBPR. Our data suggest that mechanisms underlying the blunting of the HRR might be associated with the genesis of EBPR. The association between the extent of HRR and adverse cardiovascular outcomes in patients with EBPR needs to be investigated in detail in future research.

Irving JB, Bruce RA, DeRouen TA (1977) Variations in and significance of systolic pressure during maximal exercise (treadmill) testing. Am J Cardiol 39:841–848PubMedCrossRef

Gupta MP, Polena S, Coplan N, Panagopoulos G, Dhingra C, Myers J, Froelicher V (2007) Prognostic significance of systolic blood pressure increases in men during exercise stress testing. Am J Cardiol 100:1609–1613PubMedCrossRef

Dubach P, Froelicher VF, Klein J, Oakes D, Grover-McKay M, Friis R (1988) Exercise-induced hypotension in a male population. Criteria, causes, and prognosis. Circulation 78:1380–1387PubMedCrossRef

Nezuo S, Inoue S, Kawahara Y, Tanaka J, Tamura K, Saito Y, Samukawa M, Sawayama T (1996) Clinical significance of abnormal postexercise systolic blood pressure response in patients with hypertrophic cardiomyopathy. J Cardiol 27:65–71PubMed

Kallistratos MS, Poulimenos LE, Pavlidis AN, Dritsas A, Laoutaris ID, Manolis AJ, Cokkinos DV (2012) Prognostic significance of blood pressure response to exercise in patients with systolic heart failure. Heart Vessels 27:46–52PubMedCrossRef

Dlin RA, Hanne N, Silverberg DS, Bar-Or O (1983) Follow-up of normotensive men with exaggerated blood pressure response to exercise. Am Heart J 106:316–320PubMedCrossRef

Singh JP, Larson MG, Manolio TA, O’Donnell CJ, Lauer M, Evans JC, Levy D (1999) Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study. Circulation 99:1831–1836PubMedCrossRef

Campbell L, Marwick TH, Pashkow FJ, Snader CE, Lauer MS (1999) Usefulness of an exaggerated systolic blood pressure response to exercise in predicting myocardial perfusion defects in known or suspected coronary artery disease. Am J Cardiol 84:1304–1310PubMedCrossRef

Kane GC, Askew JW, Chareonthaitawee P, Miller TD, Gibbons RJ (2008) Hypertensive response with exercise does not increase the prevalence of abnormal Tc-99m SPECT stress perfusion images. Am Heart J 155:930–937PubMedCrossRef

10.

Laukkanen JA, Kurl S, Salonen R, Lakka TA, Rauramaa R, Salonen JT (2004) Systolic blood pressure during recovery from exercise and the risk of acute myocardial infarction in middle-aged men. Hypertension 44:820–825PubMedCrossRef

11.

Erikssen G, Bodegard J, Bjornholt JV, Liestol K, Thelle DS, Erikssen J (2004) Exercise testing of healthy men in a new perspective: from diagnosis to prognosis. Eur Heart J 25:978–986PubMedCrossRef

12.

Mundal R, Kjeldsen SE, Sandvik L, Erikssen G, Thaulow E, Erikssen J (1994) Exercise blood pressure predicts cardiovascular mortality in middle-aged men. Hypertension 24:56–62PubMedCrossRef

13.

Lauer MS, Pashkow FJ, Harvey SA, Marwick TH, Thomas JD (1995) Angiographic and prognostic implications of an exaggerated exercise systolic blood pressure response and rest systolic blood pressure in adults undergoing evaluation for suspected coronary artery disease. J Am Coll Cardiol 26:1630–1636PubMedCrossRef

14.

Bouzas-Mosquera A, Peteiro J, Broullon FJ, Alvarez-Garcia N, Garcia-Bueno L, Mosquera VX, Prada O, Casas S, Castro-Beiras A (2010) Prognostic value of an exaggerated exercise blood pressure response in patients with diabetes mellitus and known or suspected coronary artery disease. Am J Cardiol 105:780–785PubMedCrossRef

15.

Miyai N, Arita M, Morioka I, Takeda S, Miyashita K (2005) Ambulatory blood pressure, sympathetic activity, and left ventricular structure and function in middle-aged normotensive men with exaggerated blood pressure response to exercise. Med Sci Monit 11:CR478–CR484PubMed

16.

Kannankeril PJ, Le FK, Kadish AH, Goldberger JJ (2004) Parasympathetic effects on heart rate recovery after exercise. J Invest Med 52:394–401CrossRef

17.

Buchheit M, Papelier Y, Laursen PB, Ahmaidi S (2007) Noninvasive assessment of cardiac parasympathetic function: postexercise heart rate recovery or heart rate variability? Am J Physiol Heart Circ Physiol 293:H8–H10PubMedCrossRef

18.

Nagashima J, Musha H, Takada H, Takagi K, Mita T, Mochida T, Yoshihisa T, Imagawa Y, Matsumoto N, Ishige N, Fujimaki R, Nakajima H, Murayama M (2010) Three-month exercise and weight loss program improves heart rate recovery in obese persons along with cardiopulmonary function. J Cardiol 56:79–84PubMedCrossRef

19.

Bruce RA, Gey GO Jr, Cooper MN, Fisher LD, Peterson DR (1974) Seattle Heart Watch: initial clinical, circulatory and electrocardiographic responses to maximal exercise. Am J Cardiol 33:459–469PubMedCrossRef

20.

Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD, Winters WL Jr, Yanowitz FG, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Lewis RP, O’Rourke RA, Ryan TJ (1997) ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation 96:345–354PubMedCrossRef

21.

Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS (2000) Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA 284:1392–1398PubMedCrossRef

22.

Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS (2003) Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol 42:831–838PubMedCrossRef

23.

Gera N, Taillon LA, Ward RP (2009) Usefulness of abnormal heart rate recovery on exercise stress testing to predict high-risk findings on single-photon emission computed tomography myocardial perfusion imaging in men. Am J Cardiol 103:611–614PubMedCrossRef

24.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463PubMedCrossRef

25.

Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613–618PubMedCrossRef

26.

Cuspidi C, Meani S, Negri F, Giudici V, Valerio C, Sala C, Zanchetti A, Mancia G (2009) Indexation of left ventricular mass to body surface area and height to allometric power of 2.7: is the difference limited to obese hypertensives? J Hum Hypertens 23:728–734PubMedCrossRef

27.

Chang HJ, Chung J, Choi SY, Yoon MH, Hwang GS, Shin JH, Tahk SJ, Choi BI (2004) Endothelial dysfunction in patients with exaggerated blood pressure response during treadmill test. Clin Cardiol 27:421–425PubMedCrossRef

28.

Javorka M, Zila I, Balharek T, Javorka K (2002) Heart rate recovery after exercise: relations to heart rate variability and complexity. Braz J Med Biol Res 35:991–1000PubMedCrossRef

29.

Tulumen E, Khalilayeva I, Aytemir K, Ergun Baris Kaya FE, Sinan Deveci O, Aksoy H, Kocabas U, Okutucu S, Tokgozoglu L, Kabakci G, Ozkutlu H, Oto A (2011) The reproducibility of heart rate recovery after treadmill exercise test. Ann Noninvasive Electrocardiol 16:365–372PubMedCrossRef

30.

Chen JY, Lee YL, Tsai WC, Lee CH, Chen PS, Li YH, Tsai LM, Chen JH, Lin LJ (2011) Cardiac autonomic functions derived from short-term heart rate variability recordings associated with heart rate recovery after treadmill exercise test in young individuals. Heart Vessels 26:282–288PubMedCrossRef

31.

Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS (1999) Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 341:1351–1357PubMedCrossRef

32.

Lipinski MJ, Vetrovec GW, Froelicher VF (2004) Importance of the first two minutes of heart rate recovery after exercise treadmill testing in predicting mortality and the presence of coronary artery disease in men. Am J Cardiol 93:445–449PubMedCrossRef

33.

Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, Do D, Myers J (2001) Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol 38:1980–1987PubMedCrossRef

34.

Aktas MK, Ozduran V, Pothier CE, Lang R, Lauer MS (2004) Global risk scores and exercise testing for predicting all-cause mortality in a preventive medicine program. JAMA 292:1462–1468PubMedCrossRef

35.

Acanfora D, De Caprio L, Cuomo S, Papa M, Ferrara N, Leosco D, Abete P, Rengo F (1988) Diagnostic value of the ratio of recovery systolic blood pressure to peak exercise systolic blood pressure for the detection of coronary artery disease. Circulation 77:1306–1310PubMedCrossRef

36.

Ellis K, Pothier CE, Blackstone EH, Lauer MS (2004) Is systolic blood pressure recovery after exercise a predictor of mortality? Am Heart J 147:287–292PubMedCrossRef

37.

Leuenberger U, Sinoway L, Gubin S, Gaul L, Davis D, Zelis R (1993) Effects of exercise intensity and duration on norepinephrine spillover and clearance in humans. J Appl Physiol 75:668–674PubMed

38.

Saito M, Tsukanaka A, Yanagihara D, Mano T (1993) Muscle sympathetic nerve responses to graded leg cycling. J Appl Physiol 75:663–667PubMed

39.

Cameron JD, Stevenson I, Reed E, McGrath BP, Dart AM, Kingwell BA (2004) Accuracy of automated auscultatory blood pressure measurement during supine exercise and treadmill stress electrocardiogram-testing. Blood Press Monit 9:269–275PubMedCrossRef

40.

Furtado EC, Ramos Pdos S, Araujo CG (2009) Blood pressure measurement during aerobic exercise: subsidies for cardiac rehabilitation. Arq Bras Cardiol 93:45–52PubMedCrossRef

41.

Onat A (2001) Risk factors and cardiovascular disease in Turkey. Atherosclerosis 156:1–10PubMedCrossRef

42.

Manolio TA, Burke GL, Savage PJ, Sidney S, Gardin JM, Oberman A (1994) Exercise blood pressure response and 5-year risk of elevated blood pressure in a cohort of young adults: the CARDIA study. Am J Hypertens 7:234–241PubMedCrossRef

43.

Ilia R, Carmel S, Tsatskis B, Gueron M (1998) Exaggerated blood pressure response at exercise in normotensive subjects: demographic and stress performance characteristics. Am Heart J 136:499–503PubMedCrossRef

44.

Papavasileiou MV, Thomopoulos C, Antoniou I, Papadimitriou G, Seferou M, Makris TK (2009) Impaired glucose metabolism and the exaggerated blood pressure response to exercise treadmill testing in normotensive patients. J Clin Hypertens (Greenwich) 11:627–635CrossRef

Title: Blunted heart rate recovery is associated with exaggerated blood pressure response during exercise testing
Authors: Umuttan Dogan
Mehmet Akif Duzenli
Kurtulus Ozdemir
Hasan Gok
Publication date: 01-11-2013
Publisher: Springer Japan
Published in: Heart and Vessels / Issue 6/2013
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-012-0298-6

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Blunted heart rate recovery is associated with exaggerated blood pressure response during exercise testing

Abstract

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Abstract

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