ARS | Publication request: Systolic blood pressure reactivity during submaximal exercise and acute psychological stress in youth

Submitted to: American Journal of Hypertension
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: October 6, 2012
Publication Date: March 1, 2013
Citation: Lambiase, M.J., Dorn, J., Roemmich, J.N. 2013. Systolic blood pressure reactivity during submaximal exercise and acute psychological stress in youth. American Journal of Hypertension. 26(3):409-415.

Interpretive Summary: Cardiovascular disease (CVD) remains the leading cause of death in the United States and the Western World [1-3]. Advances in non-invasive imaging technology have allowed in vivo study of the structural and functional properties of the arterial system and can be used to identify an increased risk for CVD as early as childhood [4-8]. Studying CVD risk factors in children and adolescents is important because the antecedents of CVD occur in youth [9-11], decades before any clinical signs or symptoms appear [7, 10]. A growing body of literature shows an association between cardiovascular reactivity to acute psychological stress and subclinical CVD risk in youth, with several studies showing an association between systolic blood-pressure (SBP) reactivity to acute psychological stress and ultrasound measured carotid artery intima-media thickness (CIMT) in both children [11] and adolescents [12]. Similar cardiovascular adjustments are observed during both acute psychological stress and submaximal exercise. Notably, greater absolute SBP during exercise is correlated with carotid atherosclerosis [13], hypertension [14] and CVD mortality [15] in adults and is associated with CVD risk factors in youth [16]. However, no studies to date have determined whether the increase in SBP above baseline, or SBP reactivity, during submaximal exercise is associated with CIMT in youth, similar to SBP reactivity during acute psychological stress.

Technical Abstract: Background: Studies in youth show an association between systolic blood-pressure (SBP) reactivity to acute psychological stress and carotid artery intima-media thickness (CIMT). However, it has not yet been determined whether SBP reactivity during submaximal exercise is also associated with CIMT in youth. Understanding the relationship between SBP reactivity to both psychological stress and submaximal exercise with measures of subclinical cardiovascular disease (CVD) risk in youth is important to determine how cardiovascular reactivity may be associated with a greater risk of CVD later in life. Methods: Fifty-four adolescents, ages 13-16 years completed three visits. On one day adolescents completed three, 4-minute stages of increasing intensity on a treadmill. On another day, adolescents completed measures of acute psychological stress reactivity (star tracing, speech preparation, speech). On a third visit adolescents completed an ultrasound scan to measure CIMT. Results: SBP reactivity during higher intensity submaximal exercise was positively associated with SBP reactivity during star tracing (ß=0.34, p=0.01), speech preparation (ß=0.37, p=0.007), and speech (ß=0.41, p=0.003). SBP reactivity during lower (ß=0.29, p=0.03) and higher (ß=0.31, p=0.02) intensity submaximal exercise predicted CIMT, similar to SBP reactivity during acute psychological stress. Conclusions: A general tendency for adolescents to be more reactive to a variety of stressors was observed. Greater SBP reactivity during submaximal exercise was associated with greater CIMT in healthy adolescents.