Background and Aims: The metabolic syndrome (MetS) increases the risk of cardiovascular disease (CVD) and type 2 diabetes. CVD risk may be heterogeneous depending of the constituents of MetS. Exercise-induced hypertension (EIH) which is related to future hypertension and is associated with a higher risk of cardiovascular disease has never been assessed in this population. The aim of this study was to evaluate EIH in subjects with MetS and to explore potential relationships with metabolic and anthropometric variables.
Methods and Materials: 181 normotensive men with MetS free of any medications underwent a symptom-limited treadmill test. Blood pressure was measured after 5 min rest (anticipatory blood pressure), every 3 min during exercise and during the recovery period. EIH was defined as maximum systolic blood pressure (SBP) >=220 mmHg and/or maximum diastolic blood pressure (DBP) >=100 mmHg. Anthropometric parameters, blood pressure, lipid profile, glucose and insulin levels were assessed fasted a week prior exercise test. Insulin resistance (IR) was derived from HOMA. Body composition and abdominal fat distribution were also assessed.
Results: Among all participants, 87 (48%) presented EIH. Maximal exercise BP were 231+/-18/99*13 mmHg in EIH participants and 197*15/83*10 mmHg in subjects with normal response to exercise (NRE) (p<0,001). Resting BP at baseline were 127+/-10/83+/-6 mmHg in EIH and 119*9/80*7 mmHg (p=0,01 for both) in NRE. Anticipatory SBP and DBP were higher in the group with EIH (146+/-12/85*12 mmHg vs. 134+/-11/80+/-10 mmHg, p=0,001). HR recuperation was lower in EIH at 2 min (52+/-12 vs. 57+/-11 bpm; p=0,04). Subjects with EIH presented higher waist circumference (WC) (111+/-8 vs. 105+/-8 cm; p<0,01). LDL-cholesterol and Apo-B were higher in EIH (3,3+/-0,5 vs. 3,0+/-0,5 mmol/l; 1,3+/-0,1 vs. 1,0+/-0,1 mmol/l; all p<0,05) as well as IR (4,4*2,0 vs. 3,8*2, p=0,03). Subjects with EIH presented higher abdominal visceral fat (263+/-70 vs 234+/-67 cm2, p<0,001) than subjects with NRE whereas abdominal subcutaneous fat and total fat mass were comparable between groups. The best predictors of EIH were resting SBP and WC. Each increment of 5 cm in WC was associated with an OR of 1,30 (1,20-1,68) for EIH.
Conclusions: In subjects with MetS, EIH is associated with a worsen metabolic and anthropometric profiles. MetS represented an heterogeneous population of subjects in which a treadmill exercise test might be useful in the determination of subject with higher cardiovascular risk, unmasking subjects with EIH.