Attenuated Heart Rate Recovery After Exercise Testing and Risk of Incident Hypertension in Men

Although attenuated heart rate recovery (HRR) and reduced heart rate (HR) reserve to maximal exercise testing are associated with adverse cardiovascular outcomes, their relation to incident hypertension in healthy normotensive populations is unclear. We examined the hypothesis that both attenuated HRR and reduced HR reserve to exercise testing are associated with incident hypertension in men.

A total of 1,855 participants were selected comprising of healthy, initially normotensive men who underwent peak or symptom-limited treadmill testing at baseline. HRR was calculated as the difference between peak HR during exercise testing and the HR at 2 minutes after exercise cessation. HR reserve was calculated as the percentage of HR reserve (peak HR - resting HR)/(220 - age - resting HR) × 100.

During an average 4-year follow-up, 179 (9.6%) men developed hypertension. Incident hypertension was associated with HRR quartiles (Q1 (<42 (bpm)) 12.5%, Q2 (43-49 bpm) 8.5%, Q3 (50-56 bpm) 9.3%, and Q4 (>57 bpm) 8.3%; P = 0.05 for trend). The relative risk (RR) of the incident hypertension in the slowest HRR quartile vs. the fastest HRR quartile was 1.78 (95% confidence interval (CI): 1.14-2.78) after adjustment for confounders. Every 1 bpm increment in HRR was associated with a 2% (RR 0.98, 95% CI: 0.97-0.99) lower risk of incident hypertension after adjusting for potential confounders. In contrast, reduced HR reserve did not predict the risk of incident hypertension.

Slow HRR after exercise testing is independently associated with the development of hypertension in healthy normotensive men.