Oftentimes, a high systolic blood pressure (the top number) can indicate poor heart health, but does the same hold true when your blood pressure spikes due to exercise?

To answer this question, researchers at Stanford looked at stress test results taken both at rest and at peak exercise of 7,500 men collected over the course of 20 years and compared them to their mortality rates.

The study, which was published in the European Journal of Preventive Cardiology, found that high systolic blood pressure during exercise may not necessarily indicate that a person is at risk for heart disease—as long as workload, or intensity, is taken into account.

Current guidelines from the American Heart Association define an exaggerated systolic blood pressure (SBP) response to exercise as a peak SBP of 210 millimeters of mercury (mmHg) in males and 190 mmHg in females. These high blood pressure (BP) levels are often interpreted to show increased risk of heart disease.

However, in this study, researchers found that higher the peak systolic blood pressure during treadmill testing, better the health prognosis of the individual. Meaning, that people reaching a higher SBP value lived longer than those with low SBP at peak exercise.

Why? Physiologically, systolic blood pressure rises with rising workload (like during a treadmill or bicycle stress test), Kristofer Hedman, Ph.D., physician at Linkoping University in Sweden told Runner’s World. People who are fitter—which is related to higher survival rates—are usually able to reach higher workloads, spiking their BP higher.

Especially in well-trained athletes, achieving high workloads also means a high blood pressure reading at peak exercise, well above current thresholds. In well-trained athletes, performing close to 20 METs (running at 13 mph, or a 4.6-minute mile), it is not uncommon to see SBP values around 250 mmHg, but for an unfit individual, that would be a high SBP reading, as they might reach only 6 to 7 METs (a slow jog), explained Hedman.

Unless the reading is extremely high—a value over 260–270 mmHg would probably never be considered “normal”—it is likely not indicative of anything else than a high fitness level, as long as the test is normal in all other aspects, Hedman said. These would include the heart rate response, the electrocardiogram (ECG), and/or symptoms such as chest pain, excessive dyspnea (labored breathing), and nausea.

“So, if you have a great fitness, you will achieve a high workload, thus probably a higher systolic BP, and have a better prognosis,” said Hedman.

On the flip side, though, higher SBP alone doesn’t mean better fitness. Rather, in healthy people, rising SBP will follow rising METs.

This shows that it’s important for physicians to take workload into account, rather than just looking at the blood pressure reading when interpreting results of things like stress tests. Higher systolic blood pressure in a person at a high workload—say, sprinting—is not as troubling as a high SP in a person reaching a low workload, like at an easy jog.

“An important contribution of our work is that we show that accounting for workload is probably more appropriate and should be considered in all cases,” Hedman said. “This is largely neglected today.”

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According to the AHA, around 103 million adults in the United States have high blood pressure. They expect that this number will continue to rise.

Meanwhile, the Centers for Disease Control and Prevention (CDC) estimate that around 1,100Trusted Source people die of a condition related to hypertension each day, including heart disease and stroke. These are some of the leading causes of death in the U.S.

The healthcare costs of hypertension are not negligible, either. The CDC suggest that hypertension results in almost $50 billion per year in costs, including the price of medications and missed days of work.

What are some of the measures that people with high blood pressure and healthcare professionals can take to prevent these adverse outcomes and increase lifespan? In 2017, the AHA recommended lowering blood pressure thresholds and treating people at risk more intensively.

Now, two new studies — both of which featured at the AHA’s Scientific Sessions 2019, which takes place in Philadelphia, PA — have investigated the costs and benefits of treating hypertension more intensively, and of tailoring treatment according to degrees of cardiovascular risk.

Better blood pressure control lengthens life

Dr. Muthiah Vaduganathan, an instructor of medicine at Harvard Medical School and an associate physician at Brigham and Women’s Hospital — both in Boston, MA — is the lead author of the first study.

Dr. Vaduganathan and team used data from the well-known Systolic Blood Pressure Intervention Trial (SPRINT).

The SPRINT examined the effects of lowering systolic blood pressure readings to a target of 120 milligrams of mercury (mm Hg) instead of the usual 140 mm Hg.

The trial followed 9,361 participants, all of whom were over the age of 50 and at high cardiovascular risk. The SPRINT followed them for 6 years and concluded that lowering blood pressure targets reduced the risk of cardiovascular problems — such as heart attack, stroke, heart failure, and cardiovascular death — by 25%.

The participants were at high risk of heart disease if they had had a cardiovascular disease that was not stroke, scored highly on the 10 year cardiovascular risk score, had chronic kidney disease, or were older than 75.

For the new study, the researchers analyzed the data to project the lifespans of the participants who underwent intensive hypertension treatment to lower blood pressure to a target of 120 mm Hg. They compared these projected lifespans with those of participants who received the standard treatment that aimed for a blood pressure of lower than 140 mm Hg.

The study revealed that intensive blood pressure treatment increased lifespan by 4–9%, compared with standard care.

“In contrast with the oldest patients, middle-aged patients had the greater absolute benefit because they start with a longer expected lifespan and can receive the intensive treatment over a longer period of time,” explains Dr. Vaduganathan.

Dr. Mitchell S. V. Elkind — the AHA president-elect and chair of the Advisory Committee of the American Stroke Association — comments on the results. He says, “This analysis of the [SPRINT] suggests that [there are] additional years of life that can be added by more aggressive control of blood pressure.”

He adds, “When you tell people that lowering their blood pressure is going to reduce their chance of having a stroke or a heart attack by 25%, which is what [the SPRINT] showed,” the question that naturally ensues is “what does that number mean, in real terms?”

“High blood pressure has been implicated as one of the reasons for stalled progress in reducing heart disease-related deaths in the United States,” Dr. Vaduganathan says. “These data reinforce that tighter blood pressure control, especially when started earlier in life, may meaningfully prolong lifespan.”

New guidelines to treat an extra 5.2 million

The second study examined the best way to implement the new blood pressure guidelines issued by the American College of Cardiology (ACC) and the AHA.

These new guidelines lowered blood pressure thresholds to define hypertension as anything from 130/80 mm Hg to 140/90 mm Hg.

The new guidelines also recommend medication treatment for people with a blood pressure reading of 130/80 mm Hg to 139/89 mm Hg if they have a history of heart attack or stroke, or if they have a high 10 year risk of experiencing such an event.

Joanne M. Penko — a research data analyst at the University of California, San Francisco — is the lead author of this second study.

To assess the cost effectiveness of implementing the new guidelines, Penko and colleagues looked at healthcare costs and quality-adjusted life years (QUALY). They used the Cardiovascular Disease Policy Model, a well-known computer simulation model, to estimate healthcare costs over a 10 year period.

Compared with the 2003 guidelines, the analysis revealed, the “2017 ACC/AHA guidelines would treat 5.2 million more adults 35–84 years of age, intensify treatment in another 11.7 million, and prevent about 257,000 [cardiovascular] events over 10 years.”

Intensifying treatment pays off over a 10 year period for men aged 65–84 and women aged 75–84 who already have cardiovascular disease. For others, however, the costs outweigh the benefits.

Furthermore, treating people at high cardiovascular risk who had not had cardiovascular disease would only be intermediately cost effective for adults whose blood pressure readings are 140/90 mm Hg or higher at baseline. It would not be cost effective at all for those whose blood pressure readings are 130/80 mm Hg to 139/89 mmHg.

“Previous studies have shown that compared with no treatment, treating high blood pressure according to the 2003 Seventh Report is cost effective over 10 years,” Penko says. “We were surprised to learn in our study that wasn’t the case for all patients indicated for medication treatment in the 2017 guidelines.”

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Obesity is one of the most common health conditions among populations around the globe.

In the United States, data from the Centers for Disease Control and Prevention (CDC) indicate that this metabolic condition affected 93.3 millionTrusted Source adults in 2015–2016.

This health issue concerns doctors, in part, because it can predispose individuals to developing other conditions, including type 2 diabetes, heart disease, and some forms of cancer.

But the risks of developing additional health problems are different for women, compared with men, according to a new study from the University of Oxford, in the United Kingdom.

Moreover, the study suggests that obesity may increase the risk for more — and more diverse — health conditions than doctors had previously realized.

The researchers published a summary of their findings in PLOS Genetics this month.

“It is increasingly evident that obesity negatively impacts human health, and the prevalence of obesity is increasing worldwide. Both overall obesity and fat distribution […] have been linked to cardiometabolic diseases and death in observational studies,” the authors note in the introduction to their study paper.

“However,” they add, “sex-specific relationships are largely unexplored, as is the role that obesity traits play in the leading causes of death beyond these cardiometabolic diseases.”

Women face higher diabetes risk

For the current research, first author Dr. Jenny Censin and colleagues analyzed genetic information and three different measures of obesity in a cohort of 228,466 women and 195,041 men.

The measures of obesity were: body mass index (BMI), waist-hip ratio, and waist-hip ratio adjusted for BMI. The investigators were able to access these data via the UK Biobank.

Through this analysis, Dr. Censin and the team found that obesity can increase a person’s risk of a range of health conditions. These include coronary artery disease, stroke, type 1 diabetes, type 2 diabetes, chronic obstructive pulmonary disease, nonalcoholic fatty liver disease, chronic liver disease, kidney failure, and lung cancer.

Moreover, they found some differences in risk when comparing data from men and women with obesity. As it turns out, women with obesity face a higher risk of type 2 diabetes than men with obesity.

Men, on the other hand, have a higher risk of chronic obstructive pulmonary disease and chronic kidney disease, compared with women who have obesity.

“This study shows just how harmful carrying excess weight can be to human health, and that women and men may experience different diseases as a result,” says Dr. Censin.

These findings, the team notes, add to the evidence that preventing and treating obesity is a crucial step in preventing the emergence of other health conditions.

“Given the compelling evidence of harm that arises as a consequence of obesity across a broad range of diseases that result in death, our findings highlight the critical need for public health measures to stem the tide of obesity.”

Going forward, the evidence that obesity likely contributes to such a wide range of health conditions could reshape public health strategies aimed at prevention, the investigators note.

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Some people go to the doctor and find the intake so nerve-wracking their blood pressure spikes. Others find the routine relaxing, as they’re asked to rest for a moment and breathe easy before a blood pressure cuff is wrapped around their arm.

People with borderline hypertension in both categories should confirm the readings by measuring their blood pressure outside their health care provider’s office, according to new research published Monday in the American Heart Association journal Hypertension.

Nearly 93 percent of U.S. adults who have high blood pressure when measured in their doctor’s office and don’t take blood pressure medicine meet the criteria for “white coat hypertension” because their blood pressure is in an acceptable range when re-measured outside a medical setting. Meanwhile, about a third of U.S. adults experience “masked hypertension” because their blood pressure levels measured outside of the doctor’s office are more problematic than measurements at the doctor’s office.

“For some people, a doctor’s office is a place they’re relaxed,” said Paul Muntner, an epidemiologist at the University of Alabama at Birmingham and the study’s senior author. “They are away from job stress, traffic and family issues.”

Others, he said, get anxious they are about to get bad news about their blood pressure – or something worse. Their readings in the doctor’s office cause concern whereas measuring in a more familiar setting would cause less stress.

In either case, the study used the American College of Cardiology and American Heart Association guidelines to determine that as many as 104 million Americans routinely should use a blood pressure machine at home to provide backup for – or a contrast with – the results from their visit to the doctor’s office. People are considered to have high blood pressure if their systolic, or top number, is 130 or higher and their diastolic, or bottom number, is 80 or higher.

Measuring blood pressure outside of a medical setting doesn’t have to be expensive or difficult.

Many pharmacies or grocery stores have blood pressure machines customers can use for free. Reliable home versions with an electronic inflatable cuff can be found at local drug stores for less than $50, and Muntner said the device should be one that already has been tested and validated.

Other options, such as ambulatory blood pressure machines, can be more involved. Those provide readings throughout the day and night and can flag hypertension while people are asleep.

But the sheer size of the population the study suggests should be measuring their blood pressure at home could make it a daunting task to achieve, said Dr. Raymond R. Townsend, who was not associated with the study.

“How many people would be well served by out-of-office blood pressure monitoring? My answer would be virtually anybody,” said Townsend, who heads up the high blood pressure program at the Hospital of the University of Pennsylvania in Philadelphia. “I think that’s a little ambitious.”

The study concedes there are barriers to widespread blood pressure monitoring at home: patient compliance, accuracy of the results, out-of-pocket costs of the device and the time needed to instruct patients on how to take their blood pressure.

What is not subject to debate is the importance of controlling hypertension. The consequences of unmanaged high blood pressure can include heart disease, stroke and organ damage.

And, Muntner said, the study makes a case that there is a benefit to getting more people to check their blood pressure on their own.

“For individual patients, hopefully it means people will be more engaged with their own health care and not just when they go to the doctor’s office.”

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