Relation of Maximum Blood Pressure During Exercise and Regular Physical Activity in Normotensive Men With Left Ventricular Mass and Hypertrophy Luis Molina, MD, PhD, Roberto Elosua, MD, PhD, Jaume Marrugat, MD, PhD, Silvia Pons, MD, and the MARATHOM Investigators* The relation between maximum systolic blood pressure (BP) during exercise and left ventricular (LV) mass is controversial. Physical activity also induces LV mass in- crease. The objective was to assess the relation between BP response to exercise and LV mass in normotensive men, taking into account physical activity practice. A cross-sectional study was performed. Three hundred eighteen healthy normotensive men, aged between 20 and 60 years, participated in this study. The Minnesota questionnaire was used to assess physical activity prac- tice. An echocardiogram and a maximum exercise test were performed. LV mass was calculated and indexed to body surface area. LV hypertrophy was defined as a ventricular mass index >134 g/m 2 . BP was measured at the moment of maximum effort. Hypertensive re- sponse was considered when BP was >210 mm Hg. In the multiple linear regression model, maximum systolic BP was associated with LV mass index and correlation coefficient was 0.27 (SE 0.07). Physical activity practice and age were also associated with LV mass. An associ- ation between hypertensive response to exercise and LV hypertrophy was observed (odds ratio 3.16). Thus, BP response to exercise is associated with LV mass and men with systolic BP response >210 mm Hg present a 3-times higher risk of LV hypertrophy than those not reaching this limit. Physical activity practice is related to LV mass, but not to LV hypertrophy. 1999 by Ex- cerpta Medica, Inc. (Am J Cardiol 1999;84:890 – 893) E xaggerated blood pressure (BP) response to exer- cise may be a predictor of future systemic hyper- tension in normotensives 1 and in borderline hyperten- sive men, 2 but the association of maximum systolic BP during exercise and left ventricular (LV) mass or LV hypertrophy is controversial. 3,4 A direct relation between BP response to exercise and LV mass has been observed in some studies both in normoten- sives 5–7 and hypertensives. 8,9 Nevertheless, some in- vestigators concluded that this association is explained by differences in age, resting systolic BP, or body mass index. 3,10 These issues are important because LV mass has been related to morbidity and mortality in hypertensives. 11,12 A slight increase in LV mass in response to regular physical activity practice has been described 13,14 and an upper physiologic limit for this hypertrophy has been proposed. 15 In hypertensive men, regular physical activity practice cannot only reduce BP but also LV mass. 16,17 Physical activity seems to induce LV mass increase in healthy people (physiologic hypertrophy) and LV mass decrease in hypertensive patients (regression of pathologic hyper- trophy). The present study assesses the relation be- tween BP response to exercise and LV mass and hypertrophy in normotensive men, taking into account not only the classic confounding variables, but also regular physical activity practice, which is often over- looked. METHODS Subjects: In the Medida de la Actividad fisica y su Relacio ´n Ambiental con Todos los Lı ´pidos en el HOMbre (Physical Activity Measurement and Its Re- lation to All Lipids in Men; MARATHOM) study, 18 537 men aged between 20 and 60 years were recruited in a balanced representation of all levels of physical activity practice. A cross-sectional study design with a quota sampling frame was chosen. Participants were consecutively recruited from among the marathon run- ners living in Barcelona who participated in the 1990 Barcelona Marathon and healthy bank employees who regularly attended a preventive medical center. Echo- cardiograms were recorded in a subgroup of 318 par- ticipants (all marathon runners and a group of bank employees). In the present study we report on this subgroup of participants. Subjects with a history of neoplasia, cardiovascular disease, hypertension, or diabetes mellitus were ex- From the Servei de Cardiologia, Hospital del Mar Universitat Au- to ` noma de Barcelona, Barcelona; Unitat de Lipids i Epidemiologia Cardiovascular, Institut Municipal d’Investigacio ´ Me ´ dica, Barcelona; and Servei de Cardiologia, Hospital de Barcelona, Barcelona, Spain. This study was supported by Grant 90/0668 of the Fondo de Inves- tigaciones Sanitarias, Madrid; and 1997/SGR 00218 from the Comissionat per Universitats i Recerca, Barcelona, Spain. Manuscript received February 22, 1999; revised manuscript received May 20, 1999, and accepted May 24. Address for reprints: Luis Molina, MD, Servei de Cardiologia, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain. E-mail: 17040@imas.imim.es. * MARATHOM Investigators participating in this study: Andreu Ar- quer, Marı ´a-Isabel Covas, Roberto Elosua, Jaume Marrugat, Silvia Martı ´n, Luis Molina, Silvia Pons, and Juan Rubie ´ s-Prat. 890 ©1999 by Excerpta Medica, Inc. All rights reserved. 0002-9149/99/$–see front matter The American Journal of Cardiology Vol. 84 October 15, 1999 PII S0002-9149(99)00460-9