Skip to main content

Advertisement

SpringerLink
Log in

Association of von Willebrand factor blood levels with exercise hypertension

  • Original Article
  • Published:
European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

A hypertensive response to moderate intensity exercise (HRE) is associated with increased cardiovascular risk. The mechanisms of an HRE are unclear, although previous studies suggest this may be due to haemostatic and/or haemodynamic factors. We investigated the relationships between an HRE with haemostatic and hemodynamic indices.

Methods

Sixty-four participants (57 ± 10 years, 71 % male) with indication for exercise stress testing underwent cardiovascular assessment at rest and during moderate intensity exercise, from which 20 participants developed an HRE (defined as moderate exercise systolic BP ≥170 mmHg/men and ≥160 mmHg/women). Rest, exercise and post-exercise blood samples were analysed for haemostatic markers, including von Willebrand factor (vWf), and haemodynamic measures of brachial and central blood pressure (BP), aortic stiffness and systemic vascular resistance index (SVRi).

Results

HRE participants had higher rest vWf compared with normotensive response to exercise (NRE) participants (1,927 mU/mL, 95 % CI 1,240–2,615, vs. 1,129 mU/mL, 95 % CI 871–1,386; p = 0.016). vWf levels significantly decreased from rest to post-exercise in HRE participants (p = 0.005), whereas vWf levels significantly increased from rest to exercise in NRE participants (p = 0.030). HRE participants also had increased triglycerides, rest BP, aortic stiffness and exercise SVRi (p < 0.05 for all). Rest vWf predicted exercise brachial systolic BP (β = 0.220, p = 0.043; adjusted R 2 = 0.451, p < 0.001) independent of age, sex, body mass index, triglycerides, rest brachial systolic BP and aortic stiffness.

Conclusions

Increased rest blood levels of vWf are independently associated with moderate intensity exercise systolic BP. These findings implicate abnormalities in haemostasis as a possible factor contributing to HRE at moderate intensity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

BP:

Blood pressure

CI:

Confidence interval

HDL :

High-density lipoprotein

HRE:

Hypertensive response to exercise

LDL:

Low-density lipoprotein

NRE:

Normotensive response to exercise

PP:

Pulse pressure

SVRi:

Systemic vascular resistance index

TAT:

Thrombin–antithrombin

TF:

Tissue factor

vWf:

von Willebrand factor

References

  • Blann A (1993) von Willebrand factor and the endothelium in vascular disease. Br J Biomed Sci 50:125–134

    CAS  PubMed  Google Scholar 

  • Blann AD, Naqvi T, Waite M, McCollum CN (1993) von Willebrand factor and endothelial damage in essential hypertension. J Hum Hypertens 7:107–111

    CAS  PubMed  Google Scholar 

  • Cameron JD, Stevenson I, Reed E, McGrath BP, Dart AM, Kingwell BA (2004) Accuracy of automated auscultatory blood pressure measurement during supine exercise and treadmill stress electrocardiogram-testing. Blood Press Monit 9:269–275

    Article  PubMed  Google Scholar 

  • Charloux A et al (2000) A new impedance cardiograph device for the non-invasive evaluation of cardiac output at rest and during exercise: comparison with the “direct” Fick method. Eur J Appl Physiol 82:313–320

    Article  CAS  PubMed  Google Scholar 

  • Chobanian AV et al (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289:2560–2572. doi:10.1001/jama.289.19.2560

    Article  CAS  PubMed  Google Scholar 

  • Daida H, Allison TG, Squires RW, Miller TD, Gau GT (1996) Peak exercise blood pressure stratified by age and gender in apparently healthy subjects. Mayo Clin Proc 71:445–452. doi:10.1016/s0025-6196(11)64085-8

    Article  CAS  PubMed  Google Scholar 

  • El Assaad MA, Topouchian JA, Darne BM, Asmar RG (2002) Validation of the Omron HEM-907 device for blood pressure measurement. Blood Press Monit 7:237–241

    Article  PubMed  Google Scholar 

  • Fagard RH, Pardaens K, Staessen JA, Thijs L (1996) Prognostic value of invasive hemodynamic measurements at rest and during exercise in hypertensive men. Hypertension 28:31–36

    Article  CAS  PubMed  Google Scholar 

  • Holland DJ, Sacre JW, McFarlane SJ, Coombes JS, Sharman JE (2008) Pulse wave analysis is a reproducible technique for measuring central blood pressure during hemodynamic perturbations induced by exercise. Am J Hypertens 21:1100–1106. doi:10.1038/ajh.2008.253

    Article  PubMed  Google Scholar 

  • Jilma B et al (1997) Partial blockade of nitric oxide synthase blunts the exercise-induced increase of von Willebrand factor antigen and of factor VIII in man. Thromb Haemost 78:1268–1271

    CAS  PubMed  Google Scholar 

  • Laurent S et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605. doi:10.1093/eurheartj/ehl254

    Article  PubMed  Google Scholar 

  • Lee KW, Blann AD, Lip GY (2005) High pulse pressure and nondipping circadian blood pressure in patients with coronary artery disease: relationship to thrombogenesis and endothelial damage/dysfunction. Am J Hypertens 18:104–115. doi:10.1016/j.amjhyper.2004.09.003

    Article  PubMed  Google Scholar 

  • Lip GY, Blann AD (1995) von Willebrand factor and its relevance to cardiovascular disorders. Br Heart J 74:580–583

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Mottram PM, Haluska B, Yuda S, Leano R, Marwick TH (2004) Patients with a hypertensive response to exercise have impaired systolic function without diastolic dysfunction or left ventricular hypertrophy. J Am Coll Cardiol 43:848–853. doi:10.1016/j.jacc.2003.08.057

    Article  PubMed  Google Scholar 

  • Pickering TG et al (2005) Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the subcommittee of professional and public education of the American heart association council on high blood pressure research. Circulation 111:697–716. doi:10.1161/01.CIR.0000154900.76284.F6

    Article  PubMed  Google Scholar 

  • Schultz MG, Climie RE, Nikolic SB, Ahuja KD, Sharman JE (2012) Reproducibility of cardiac output derived by impedance cardiography during postural changes and exercise. Artery Res 6(2):78–84

    Article  Google Scholar 

  • Schultz MG, Davies JE, Roberts-Thomson P, Black JA, Hughes AD, Sharman JE (2013a) Exercise central (aortic) blood pressure is predominantly driven by forward traveling waves, not wave reflection. Hypertension 62:175–182. doi:10.1161/hypertensionaha.111.00584

    Article  CAS  PubMed  Google Scholar 

  • Schultz MG, Otahal P, Cleland VJ, Blizzard L, Marwick TH, Sharman JE (2013b) Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis. Am J Hypertens 26:357–366. doi:10.1093/ajh/hps053

    Article  CAS  PubMed  Google Scholar 

  • Scott JA, Coombes JS, Prins JB, Leano RL, Marwick TH, Sharman JE (2008) Patients with type 2 diabetes have exaggerated brachial and central exercise blood pressure: relation to left ventricular relative wall thickness. Am J Hypertens 21:715–721. doi:10.1038/ajh.2008.166

    Article  PubMed  Google Scholar 

  • Sharman JE et al (2006) Validation of a generalized transfer function to noninvasively derive central blood pressure during exercise. Hypertension 47:1203–1208

    Article  CAS  PubMed  Google Scholar 

  • Stergiou GS, Giovas PP, Gkinos CP, Tzamouranis DG (2008) Validation of the A&D UM-101 professional hybrid device for office blood pressure measurement according to the international protocol. Blood Press Monit 13:37–42. doi:10.1097/MBP.0b013e3282c9acb0

    Article  PubMed  Google Scholar 

  • Stewart KJ et al (2004) Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function. Am J Hypertens 17:314–320. doi:10.1016/s0895-7061(03)01003-3

    Article  PubMed  Google Scholar 

  • Thanassoulis G et al (2012) Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study. Circulation 125:2836–2843. doi:10.1161/circulationaha.111.063933

    Article  PubMed Central  PubMed  Google Scholar 

  • Thompson SG, Kienast J, Pyke SD, Haverkate F, van de Loo JC (1995) Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European concerted action on thrombosis and disabilities angina pectoris study group. N Engl J Med 332:635–641. doi:10.1056/nejm199503093321003

    Article  CAS  PubMed  Google Scholar 

  • Tsioufis C et al (2008) Exercise blood pressure response, albuminuria, and arterial stiffness in hypertension. Am J Med 121:894–902. doi:10.1016/j.amjmed.2008.05.035

    Article  PubMed  Google Scholar 

  • Wang JS, Liao CH (2004) Moderate-intensity exercise suppresses platelet activation and polymorphonuclear leukocyte interaction with surface-adherent platelets under shear flow in men. Thromb Haemost 91:587–594. doi:10.1160/TH03-10-0644

    CAS  PubMed  Google Scholar 

  • Willeit P et al (2013) Hemostatic factors and risk of coronary heart disease in general populations: new prospective study and updated meta-analyses. PloS One 8(2):e55175. doi:10.1371/journal.pone.0055175

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Dr Warrick Bishop, Dr Mark Baldwin, Samantha Doohan, Angela Johnson and Gerard Ivory at the Calvary Cardiac Centre, Calvary Hospital, Hobart, Australia for helping the recruitment of study participants. A/Prof James E. Sharman was supported by a Career Development Award from the National Health and Medical Research Council of Australia (reference 569519).

Conflict of interest

None of the authors have a conflict of interest relevant to this work.

Ethical standards

The study was approved by the Human Research Ethics Committee of the University of Tasmania. Written informed consent was obtained from all participants and procedures were in agreement with the Declaration of Helsinki.

Author information

Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia

    Sonja B. Nikolic, Petr Otahal & James E. Sharman

  2. School of Health Sciences, University of Tasmania, Launceston, Australia

    Murray J. Adams

  3. Centre of Human and Aerospace Physiological Sciences, King’s College London, London, UK

    Lindsay M. Edwards

  4. Fibrosis Discovery Performance Unit, GlaxoSmithKline R&D, Stevenage, UK

    Lindsay M. Edwards

Authors
  1. Sonja B. Nikolic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Murray J. Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Petr Otahal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lindsay M. Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James E. Sharman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James E. Sharman.

Additional information

Communicated by Fabio Fischetti.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nikolic, S.B., Adams, M.J., Otahal, P. et al. Association of von Willebrand factor blood levels with exercise hypertension. Eur J Appl Physiol 115, 1057–1065 (2015). https://doi.org/10.1007/s00421-014-3087-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00421-014-3087-3

Keywords

Search

Navigation