Antihypertensive Medications And Peak Exercise Blood Pressure Response

An excessive rise in systolic blood pressure (SBP) during exercise is linked to increased risk of cardiovascular disease (CVD). Hypertensive individuals are more likely to have an exaggerated SBP response to exercise. However, research is limited on the impact of antihypertensive medication use on the exercise blood pressure response. PURPOSE: To determine if individuals on antihypertensive medications (excluding beta-blockers) have a normal blood pressure response to maximal exercise compared to unmedicated individuals. METHODS: Participants included 2,555 apparently healthy adults from the Ball State Adult Fitness Longitudinal Lifestyle STudy (BALL ST) cohort. Participants were divided into groups by sex and antihypertensive medications status (Male medicated, Male unmedicated, Female medicated, Female unmedicated). A 2-way analysis of covariance (Sex x Medication Status) was used to assess peak SBP between groups. A chi-squared test was used to determine the prevalence of exaggerated and blunted responses within each group using the Fitness Registry and the Importance of Exercise: A National Database (FRIEND) and absolute criteria (FRIEND Exaggerated ≥90th percentile, Blunted ≤10th percentile; Absolute exaggerated >210 mmHg for men and > 190 mmHg for women, Blunted <140 mmHg). RESULTS: Peak SBP was higher in medicated compared to unmedicated subjects (p < 0.01) in the overall cohort when controlling for age and resting SBP. When men and women were assessed independently, peak SBP remained higher in the medicated women compared to unmedicated women (p < 0.05), however the difference in peak SBP between medicated and unmedicated men was not significant after controlling for age and resting SBP (p = 0.31). Further, the unmedicated group had a greater prevalence of blunted SBP responses, whereas the medicated group had a higher prevalence of exaggerated SBP responses using both the FRIEND and absolute criteria. CONCLUSION: Individuals on antihypertensive medications had a higher prevalence of an exaggerated peak SBP response than unmedicated. Given the prognostic value of exaggerated peak SBP, individuals on antihypertensive medications should be monitored closely during peak exercise to lower risk of an adverse cardiovascular event.