Hypertensive Response to Exercise in Normotensive Men and Women with Abdominal Obesity: Association with Subclinical Adverse Cardiac Remodeling

<b>Background/Objectives:</b> Hypertensive response to exercise (HRE) is an established risk factor for cardiovascular events. HRE is prevalent among people with excess adiposity. Both obesity and HRE have been individually associated with adverse cardiac remodeling. We hypothesized that HRE would be associated with adverse measures of cardiac structure and function in a subgroup of individuals with abdominal obesity. <b>Methods:</b> In a subgroup of 158 participants with elevated waist circumference (women: ≥80 cm, men: ≥94 cm) and resting blood pressure (BP) < 140/90 mm Hg, we evaluated maximal exercise BP and peak oxygen consumption (VO_2peak) during cardiorespiratory exercise testing. HRE was defined as maximal exercise BP ≥ 90th percentile per sex and age. Cardiac structure and function on echocardiography were compared between HRE and no HRE (NHRE) groups for each sex. Multivariate linear regression was used to evaluate associations between maximal systolic BP (SBP) and echocardiographic variables, adjusting for age, body mass index, resting SBP, and VO_2peak. <b>Results:</b> Participants (75% women) were aged 53 ± 11 years old. Women with HRE had higher resting SBP and subclinical cardiac remodeling abnormalities (increased left ventricular [LV] wall thickness, relative wall thickness, and mass) than NHRE women (<i>p</i> < 0.05). Men with HRE had higher relative wall thickness than NHRE men (<i>p =</i> 0.042). There was no difference in cardiac function between HRE groups (<i>p</i> > 0.05). After adjustment, maximal SBP remained associated with adverse cardiac remodeling parameters for each sex (<i>p</i> < 0.05). <b>Conclusions:</b> Among individuals with abdominal obesity and resting BP < 140/90 mm Hg, HRE was associated with adverse cardiac remodeling. HRE represents a potential screening tool and preventive target to detect those at higher risk of preclinical cardiac changes.