An exaggerated blood pressure response to exercise is associated with subclinical myocardial dysfunction in normotensive individuals.

Objectives: An exaggerated blood pressure (BP) response to exercise is associated with adverse cardiovascular outcomes, even in normotensive individuals. The purpose of this study was to compare myocardial function between normotensive individuals with and without an exaggerated BP response.

Methods: We evaluated global myocardial function using speckle tracking echocardiography in normotensive individuals. Two-dimensional speckle tracking echocardiography and a treadmill exercise test were performed simultaneously in 171 normotensive individuals (mean age: 48 ± 8 years; 97 men) without any structural heart disease.

Results: Among 171 normotensive individuals, 19 (11%) exhibited an exaggerated BP response (≥200  mmHg for men and ≥190  mmHg for women) during the treadmill test. Conventional echocardiographic parameters were similar between the two groups. However, on strain analyses, the systolic and early diastolic global longitudinal strains of the left ventricle (LV) and left atrium were lower in individuals with an exaggerated BP response to exercise. The peak SBP during exercise was inversely related to systolic global longitudinal strain of the LV (r = -0.35, P < 0.01) and left atrium (r = -0.41, P < 0.01). On multivariate analyses, an exaggerated BP response to exercise was shown to be an independent determinant of reduced global longitudinal strain of the LV (β = -0.20, P < 0.05) and left atrium (β = -0.28, P < 0.05).

Conclusion: Normotensive individuals with an exaggerated BP response to exercise exhibit impairment in longitudinal myocardial function. Even without apparent hypertension, an exaggerated BP response could cause repeated increases in afterload and result in subclinical myocardial dysfunction.