Subclinical atherosclerosis in normotensive subjects with exaggerated blood pressure response to exercise: role of inflammation

Exaggerated blood pressure response to exercise [EBPRE] is a predictor of future hypertension in normotensives. This study aimed to clarify whether EBPRE in normotensive subjects is associated with increased risk for atherosclerosis and to examine the possible role of inflammation in this process. A total of 90 normotensive male subjects were divided according to their blood pressure response to exercise into two groups; GI: 22 subjects with EBPRE and GII: 68 subjects with normal blood pressure response to exercise [NBPRE]. Ultrasound-measured carotid artery intima-media thickness [cIMT] was used as an index for atherosclerosis and plasma C-reactive protein [CRP] was measured as a marker for systemic inflammation. Despite similar levels of traditional atherosclerotic risk factors in GI and GII, cIMT was higher in GI compared to GII [0.77 +/- 0.23 mm and 0.62 +/- 0.15 mm; respectively] and there was a positive correlation between cIMT and maximal systolic blood pressure during exercise [r=0.69, p<0.001]. The percentage of patients with increased cIMT was significantly higher in subjects of GI compared to subjects of GII. Plasma CRP was higher in GI compared to GII [1.62 +/- 0.88 mg/L and 0.92 +/- 0.41 mg/L; respectively] and there was a weak positive correlation between cIMT and CRP [r=0.42, p<0.05]. From this study it can be concluded that, even in the absence of standard risk factors for atherosclerosis, exaggerated blood pressure reactivity during physical exercise is associated with increased risk for carotid atherosclerosis in normotensive subjects. Inflammatory reaction may have, even in part, a role in this increased risk