Exercise blood pressure and cardiovascular disease risk: a systematic review and meta-analysis of cross-sectional studies

Background: A hypertensive response to exercise (HRE) is associated with cardiovascular disease and high blood pressure (BP). A poor cardiovascular risk factor profile may underlie these associations, although this has not been systematically elucidated. Via systematic review and meta-analysis, we aimed to assess the relationship between exercise BP and cardiovascular risk factors, and determine if cardiovascular risk is higher in those with an HRE vs. no-HRE across different study populations (including those with/without high BP at rest). Methods: Three online databases were searched for cross-sectional studies reporting data on exercise BP, an HRE and cardiovascular risk factors (including arterial structure, lipid, metabolic, inflammatory and kidney function markers). Random-effects meta-analyses and meta-regression were used to calculate pooled correlations between exercise BP and each risk factor and pooled mean differences between those with/without an HRE. Results: Thirty-eight studies (38 295 participants, aged 50 +/- 3years; 78% male) were included. Exercise SBP was associated with arterial, lipid and kidney function risk markers (P < 0.05). Those with an HRE had greater aortic stiffness (+0.80 +/- 0.35 m/s), total (+0.14 +/- 0.03 mmol/l) and low-density lipoprotein (+0.12 +/- 0.03 mmol/l) cholesterol, triglycerides (+0.24 +/- 0.04 mmol/l), glucose (+0.15 +/- 0.05 mmol/l), white blood cell count (+0.49 +/- 0.16 mmol/l) and albumin-to-creatinine ratio (standardized mean difference: +0.97 +/- 0.34), and lower flow-mediated dilation (-4.13 +/- 1.02%) and high-density lipoprotein cholesterol (-0.04 +/- 0.01 mmol/l) vs. those with no-HRE (P < 0.05 all). Results were broadly similar across study populations. Conclusion: Exercise SBP is associated with multiple cardiovascular risk factors, which appear worse in those with an HRE vs. no-HRE. As results were similar across population groups, an HRE should be considered an important indicator of cardiovascular risk.

Automated summary

The study found that exercise systolic blood pressure is associated with multiple cardiovascular risk factors, and individuals with a hypertensive response to exercise (HRE) exhibit worse cardiovascular risk factors compared to those with no-HRE. This relationship is consistent across different study populations.