Skip to main content
SpringerLink
Log in

Older age is associated with greater central aortic blood pressure following the exercise stress test in subjects with similar brachial systolic blood pressure

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Brachial systolic pressure (BSP) is often monitored during exercise by the stress test; however, central systolic pressure (CSP) is thought to be a more direct measure of cardiovascular events. Although some studies reported that exercise and aging may play roles in changes of both BSP and CSP, the relationship between BSP and CSP with age following the exercise stress test remains unclear. The aim of this study was to evaluate the effect of age on the relationship between BSP and CSP measured after exercise. Ninety-six subjects underwent the diagnostic treadmill exercise stress test, and we retrospectively divided them into the following 3 groups by age: the younger age group (43 ± 4 years), middle age group (58 ± 4 years), and older age group (70 ± 4 years). Subjects exercised according to the Bruce protocol, to achieve 85 % of their age-predicted maximum heart rate or until the appearance of exercise-associated symptoms. BSP, CSP, and pulse rate (PR) were measured using a HEM-9000AI (Omron Healthcare, Japan) at rest and after exercise. BSP, CSP, and PR at rest were not significantly different among the 3 groups (p = 0.92, 0.21, and 0.99, respectively). BSP and PR immediately after exercise were not significantly different among the groups (p = 0.70 and 0.38, respectively). However, CSP immediately after exercise was 144 ± 18 mmHg (younger age), 149 ± 17 mmHg (middle age), and 158 ± 19 mmHg (older age). CSP in the older age group was significantly higher than that in the younger age group (p < 0.01). Despite similar BSPs in all age groups after exercise, CSP was higher in the older age group. Therefore, older subjects have a higher CSP after exercise, which is not readily assessed by conventional measurements of BSP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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 7:234–241

    Article  CAS  PubMed  Google Scholar 

  2. Iskandrian AS, Heo J (1988) Exaggerated systolic blood pressure response to exercise: a normal variant or a hyperdynamic phase of essential hypertension? Int J Cardiol 18:207–221

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. Sharabi Y, Ben-Cnaan R, Hanin A, Martonovitch G, Grossman E (2001) The significance of hypertensive response to exercise as a predictor of hypertension and cardiovascular disease. J Hum Hypertens 15:353–356

    Article  CAS  PubMed  Google Scholar 

  5. Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S (2010) Exercise blood pressure and future cardiovascular death in asymptomatic individuals. Circulation 121:2109–2116

    Article  PubMed  PubMed Central  Google Scholar 

  6. Everson SA, Lynch JW, Kaplan GA, Lakka TA, Sivenius J, Salonen JT (2001) Stress-induced blood pressure reactivity and incident stroke in middle-aged men. Stroke 32(6):1263–1270

    Article  CAS  PubMed  Google Scholar 

  7. Kurl S, Laukkanen JA, Rauramaa R, Lakka TA, Sivenius J, Salonen JT (2001) Systolic blood pressure response to exercise stress test and risk of stroke. Stroke 32(9):2036–2041

    Article  CAS  PubMed  Google Scholar 

  8. Lauer MS, Levy D, Anderson KM, Plehn JF (1992) Is there a relationship between exercise systolic blood pressure response and left ventricular mass? The Framingham heart study. Ann Intern Med 116:203–210

    Article  CAS  PubMed  Google Scholar 

  9. Sung J, Ouyang P, Silber HA, Bacher AC, Turner KL, DeRegis JR, Hees PS, Shapiro EP, Stewart KJ (2003) Exercise blood pressure response is related to left ventricular mass. J Hum Hypertens 17:333–338

    Article  CAS  PubMed  Google Scholar 

  10. Takamura T, Onishi K, Sugimoto T, Kurita T, Fujimoto N, Dohi K, Tanigawa T, Isaka N, Nobori T, Ito M (2008) Patients with a hypertensive response to exercise have impaired left ventricular diastolic function. Hypertens Res 31:257–263

    Article  PubMed  Google Scholar 

  11. Kato S, Onishi K, Yamanaka T, Takamura T, Dohi K, Yamada N, Wada H, Nobori T, Ito M (2008) Exaggerated hypertensive response to exercise in patients with diastolic heart failure. Hypertens Res 31:679–684

    Article  PubMed  Google Scholar 

  12. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O’Rourke M (2006) Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes principal results of the conduit artery function evaluation (CAFE) Study. Circulation 113:1213–1225

    Article  CAS  PubMed  Google Scholar 

  13. Roman MJ, Devereux RB (2014) Association of central and peripheral blood pressures with intermediate cardiovascular phenotypes. Hypertension 63:1148–1153

    Article  CAS  PubMed  Google Scholar 

  14. Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J 31:1865–1871

    Article  PubMed  Google Scholar 

  15. Wang K-L, Cheng H-M, Chuang S-Y, Spurgeon HA, Ting CT, Lalatta EG, Yin FC, Chou P, Chen CH (2009) Central or peripheral systolic or pulse pressure: which best relates to target-organs and future mortality? J Hypertens 27:461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. McEniery CM, Yasmin McDonnell B, Munnery M, Wallace SM, Rowe CV, Cockcroft JR, Wilkinson IB (2008) Central pressure: variability and impact of cardiovascular risk factors: the Anglo-Cardiff collaborative trial II. Hypertension 51:1476–1482

    Article  CAS  PubMed  Google Scholar 

  17. Neisius U, Bilo G, Taurino C, McClure JD, Schneider MP, Kawecka-Jaszcz K, Stolarz-Skrzypek K, Klima Ł, Staessen JA, Kuznetsova T, Redon J, Martinez F, Rosei EA, Muiesan ML, Melander O, Zannad F, Rossignol P, Laurent S, Collin C, Lonati L, Zanchetti A, Dominiczak AF, Delles C (2012) Association of central and peripheral pulse pressure with intermediate cardiovascular phenoytpes. J Hypertens 30:67–74

    Article  CAS  PubMed  Google Scholar 

  18. Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, Umans JG, Howard BV (2007) Central pressure more strongly relates to vascular disease and outcome than does brachial pressure. The strong heart study. Hypertension 50:197–203

    Article  CAS  PubMed  Google Scholar 

  19. Takazawa K, Kobayashi H, Shindo N, Tanaka N, Yamashina A (2007) Relationship between radial and central arterial pulse wave and evaluation of central aortic pressure using the radial arterial pulse wave. Hypertens Res 30(3):219–228

    Article  PubMed  Google Scholar 

  20. Adji A, O’Rourke MF (2012) Brachial artery tonometry and the Popeye phenomenon: explanation of anomalies in generating central from upper limb pressure waveforms. J Hypertens 30:1540–1551

    Article  CAS  PubMed  Google Scholar 

  21. Magda SL, Ciobanu AO, Florescu M, Vinereanu D (2013) Comparative reproducibility of the noninvasive ultrasound methods for the assessment of vascular function. Heart Vessels 28:143–150

    Article  PubMed  Google Scholar 

  22. Holland DJ, Sacre JW, McFarlane SJ, Coombes J, Sharman J (2008) Pulse wave analysis is a reproducible technique for measuring central blood pressure during hemodynamic perturbations induced by exercise. Am J Hypertens 21:1100–1106

    Article  PubMed  Google Scholar 

  23. Sharman JE, Lim R, Wilinson AM, Coombes JS, Burgess MI, Franco J, Garrahy P, Wilkinson IB, Marwick TH (2006) Validation of a generalized transfer function to noninvasively derive central blood pressure during exercise. Hypertension 47:1203–1208

    Article  CAS  PubMed  Google Scholar 

  24. Rowell LB, Brengelmann GL, Blackmon JR, Bruce RA, Murray JA (1968) Disparities between aortic and peripheral pulse pressures induced by upright exercise and vasomotor changes in man. Circulation 37:954–964

    Article  CAS  PubMed  Google Scholar 

  25. Nichols W, O’Rourke M, Vlachopoulos C (2011) McDonald’s blood flow in arteries, sixth edition: theoretical, experimental and clinical principles, 6th edn. CRC Press, London, pp 411–446

    Google Scholar 

  26. Oishi Y, Miyoshi H, Iuchi A, Nagase N, Ara N, Oki T (2013) Vascular aging of common carotid artery and abdominal aorta in clinically normal individuals and preclinical patients with cardiovascular risk factors: diagnostic value of two-dimensional speckle-tracking echocardiography. Heart Vessels 28:222–228

    Article  PubMed  Google Scholar 

  27. Yamashina A, Ueshima K, Kimura K, Kuribayashi Y, Sakuma H, Tamaki N, Yoshida K, Kitagawa K, Kosuge M, Jinzaki M, Chikamori D, Teraoka K, Hayashida A, Harada M, Yoshioka K, Yoshinaga K, Watanabe N, Otsuji Y, Kihara Y, Nishimura S, Mizuno K, Yoshino H (2009) Guidelines for noninvasive diagnosis of coronary artery lesions (the Japanese Circulation Society), pp 1022–1025 (in Japanese)

  28. Takazawa K, Kobayashi H, Kojima I, Aizawa A, Kinoh M, Sugo Y, Shimizu M, Miyawaki Y, Tanaka N, Yamashina A, Avolio A (2012) Estimation of central aortic systolic pressure using late systolic inflection of radial artery pulse and its application to vasodilator therapy. J Hypertens 30:908–916

    Article  CAS  PubMed  Google Scholar 

  29. Sharman JE, McEniery CM, Campbell RI, Coombes JS, Wilkinson IB, Cockcroft JR (2005) The effect of exercise on large artery haemodynamics in healthy young men. Eur J Clin Invest 35:738–744

    Article  CAS  PubMed  Google Scholar 

  30. Hall JE (2009) Guyton and Hall textbook of medical physiology, 12th edn. Saunders, Philadelphia, pp 243–245

    Google Scholar 

  31. Smulyan H, Mukherjee R, Sheehe PR, Safar ME (2010) Cuff and aortic pressure differences during dobutamine infusion: a study of the effects of systolic blood pressure amplification. Am Heart J 159:399–405

    Article  CAS  PubMed  Google Scholar 

  32. Fletcher GF, Balady GJ, Amsterdam EA, Bazzarre T (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104:1694–1740

    Article  CAS  PubMed  Google Scholar 

  33. Korkushko OV, Shatilo VB, Plachinda YI, Shatilo TV (1991) Autonomic control of cardiac chronotropic function in man as a function of age: assessment by power spectral analysis of heart rate variability. J Auton Nerv Syst 32:191–198

    Article  CAS  PubMed  Google Scholar 

  34. Taylor JA, Hayano J, Seals DR (1985) Lesser vagal withdrawal during isometric exercise with age. J Appl Physiol 79(3):805–811

    Google Scholar 

  35. Dogan U, Duzenli MA, Ozdemir K, Gok H (2013) Blunted heart rate recovery is associated with exaggerated blood pressure response during exercise testing. Heart Vessels 28:750–756

    Article  PubMed  Google Scholar 

  36. Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, Vasan RS, Levy D (2004) Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham heart study. Hypertension 43:1239–1245

    Article  CAS  PubMed  Google Scholar 

  37. Vyas M, Izzojr J, Lacourciere Y, Arnold JM, Dunlap ME, Amato JL, Pfeffer MA, Mitchell GF (2007) Augmentation index and central aortic stiffness in middle-aged to elderly individuals. Am J Hypertens 20:642–647

    Article  PubMed  Google Scholar 

  38. Ding F-H, Li Y, Zhang R-Y, Zhang QI, Wang J-G (2013) Comparison of the SphygmoCor and Omron devices in the estimation of pressure amplification against the invasive catheter measurement. J Hypertens 31:86–93

    Article  CAS  PubMed  Google Scholar 

  39. Takazawa K, Tanaka N, Takeda K, Kurosu F, Ibukiyama C (1995) Underestimation of vasodilator effects of nitroglycerin by upper limb blood pressure. Hypertension 26:520–523

    Article  CAS  PubMed  Google Scholar 

  40. Pauca AL, O’Rourke MF, Kon ND (2001) Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 38:932–937

    Article  CAS  PubMed  Google Scholar 

  41. Richardson CJ, Maki-Petaja KM, McDonnell BJ, Hickson SS, Wilkinson IB, McEniery CM (2009) Comparison of estimates of central systolic blood pressure and peripheral augmentation index obtained from the Omron HEM-9000AI and SphygmoCor systems. Artery Res 3:24–31

    Article  Google Scholar 

  42. Kips JG, Schutte AE, Vermeersch SJ, Huisman HW, Van Rooyen JM, Glyn MC, Fourie CM, Malan L, Schutte R, Van Bortel LM, Segers P (2011) Comparison of central pressure estimates obtained from SphygmoCor, Omron HEM-9000AI and carotid applanation tonometry. J Hypertens 29:1115–1120

    Article  CAS  PubMed  Google Scholar 

  43. Hickson SS, Butlin M, Mir FA, Graggaber J, Cheriyan J, Khan F, Grace AA, Yasmin Cockcroft JR, Wilkinson IB, McEniery CM (2009) The accuracy of central SBP determined from the second systolic peak of the peripheral pressure waveform. J Hypertens 27:1784–1788

    Article  CAS  PubMed  Google Scholar 

  44. Mundal R, Kjeldsen SE, Sandvik L, Erikssen G, Thaulow E, Erikssen J (1998) Clustering of coronary risk factors with increasing blood pressure at rest and during exercise. J Hypertens 16:19–22

    Article  CAS  PubMed  Google Scholar 

  45. Wasserman K, Hansen JE, Sue DY, Stringer WW, Sietsema KE, Sun XG, Whipp BJ (2005) Principles of exercise testing and interpretation: including pathophysiology and clinical applications, 5th edn. Lippincott Williams & Wilkins, Philadelphia, pp 76–110

    Google Scholar 

  46. Loftin M, Sothern M, Warren B, Udall J (2004) Comparison of VO2 peak during treadmill and cycle ergometry in severely overweight youth. J Sports Sci Med 3:554–560

    PubMed  PubMed Central  Google Scholar 

  47. Shimizu M, Myers J, Buchanan N, Walsh D, Kraemer M, McAuley Froelicher VF (1991) The ventilatory threshold: method, protocol, and evaluator agreement. Am Heart J 122:509–516

    Article  CAS  PubMed  Google Scholar 

  48. Reeve JC, Abhayaratna WP, Davies JE, Sharman JE (2014) Central hemodynamics could explain the inverse association between height and cardiovascular mortality. Am J Hypertens 27:392–400

    Article  PubMed  Google Scholar 

  49. Ari Lieber, Sandrine Millasseau, Laurent Bourhis, Jacques Blacher, Athanase Protogerou, Bernard Levy I, Michel Safar E (2010) Aortic wave reflection in woman and man. Am J Physiol Heart Circ Physiol 299:236–242

    Article  Google Scholar 

  50. Doge R, Inoue A, Node K (2011) The relationship between the changes of blood pressure with exercise stress test and cardiovasuclar disease. Jpn J Clin Patbol 41:47–53

    Google Scholar 

  51. Thanassoulis G, Lyass A, Benjamin EJ, Larson MG, Vita JA, Levy D, Hamburg NM, Widlansky ME, O’Donnell CJ, Mitchell GF, Vasan RS (2012) Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study. Circulation 125:2836–2843

    Article  PubMed  PubMed Central  Google Scholar 

  52. Westerhof N, O’Rourke MF (1995) Haemodynamic basis for the development of left ventricular failure in systolic hypertension and for its logical therapy. J Hypertens 13:943–952

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We are indebted to the medical editors of the Department of International Medical Communications of Tokyo Medical University, for the editorial review of the English manuscript.

Author information

Authors and Affiliations

  1. Department of Cardiology, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku, Tokyo, 163-0023, Japan

    Masatake Kobayashi & Akira Yamashina

  2. Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan

    Kazutaka Oshima, Yoichi Iwasaki, Yuto Kumai & Kenji Takazawa

  3. Australian School of Advanced Medicine, Macquarie University, Sydney, Australia

    Alberto Avolio

Authors
  1. Masatake Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazutaka Oshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoichi Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuto Kumai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alberto Avolio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akira Yamashina
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kenji Takazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masatake Kobayashi.

Ethics declarations

Conflict of interest

The authors declare no potential conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kobayashi, M., Oshima, K., Iwasaki, Y. et al. Older age is associated with greater central aortic blood pressure following the exercise stress test in subjects with similar brachial systolic blood pressure. Heart Vessels 31, 1354–1360 (2016). https://doi.org/10.1007/s00380-015-0733-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-015-0733-6

Keywords

Search

Navigation