Purpose: To examined the correlations between hypertensive response to exercise (HRE), high-sensitivity C-reactive protein (hs-CRP), plasminogen-activator inhibitor type 1 (PAI-1) and arterial stiffening, in essential hypertensives.

Methods: 84 newly diagnosed untreated non-diabetic hypertensive subjects [58 men, mean age 52 years, office BP = 145/93 mmHg] with a negative treadmill exercise test were divided into those with HRE (n = 24) (peak systolic BP >210 mmHg in men and >190 in women) and to those without HRE (n = 60). Moreover, in all subjects venous blood samples were drawn for estimation of hs-CRP and PAI-1 levels, whereas arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV).

Results: Patients with HRE compared to those without HRE were older and had greater 24-h systolic BP. Although groups did not differ regarding metabolic profile patients with HRE as compared to those without HRE exhibited significantly higher levels of c-f PWV (8.7±1.6 vs 7.7±13 m/s), hs-CRP (5.1±1.2 vs 2.1±0.8mg/l) and PAI-1 (38.6±8.5 vs 18.9±2.6 ng/ml). In the total population, peak systolic BP was related to 24-h systolic BP (r = 0.238, p < 0.05), PWV (r = 0.288, p < 0.005) and hs-CRP (r = 0.439, p < 0.0001), whereas there was no association with PAI-1 levels (p = NS). By analysis of covariance it was revealed that PWV, hs-CRP and PAI-1 values remained significantly different between groups after adjustment for confounders (p < 0.05).

Conclusions: Hypertensives with an HRE exhibit augmented hs-CRP, PAI-1 and PWV values. These findings suggest that impaired thrombosis/fibrinolysis system, arterial stiffening and microinflammation may be mechanisms that contribute to exercise hypertension and associated increase risk.