Abstract
Guidelines recommend considering workload in interpretation of the systolic blood pressure (SBP) response to exercise, but reference values are lacking. This was a retrospective, consecutive cohort study. From 12,976 subjects aged 18-85 years who performed a bicycle ergometer exercise test at one centre in Sweden during the years 2005-2016, we excluded those with prevalent cardiovascular disease, comorbidities, cardiac risk factors or medications. We extracted SBP, heart rate and workload (watt) from ≥ 3 time points from each test. The SBP/watt-slope and the SBP/watt-ratio at peak exercise were calculated. Age- and sex-specific mean values, standard deviations and 90th and 95th percentiles were determined. Reference equations for workload-indexed and peak SBP were derived using multiple linear regression analysis, including sex, age, workload, SBP at rest and anthropometric variables as predictors. A final sample of 3839 healthy subjects (n = 1620 female) were included. While females had lower mean peak SBP than males (188 ± 24 vs 202 ± 22 mmHg, p < 0.001), workload-indexed SBP measures were markedly higher in females; SBP/watt-slope: 0.52 ± 0.21 versus 0.41 ± 0.15 mmHg/watt (p < 0.001); peak SBP/watt-ratio: 1.35 ± 0.34 versus 0.90 ± 0.21 mmHg/watt (p < 0.001). Age, sex, exercise capacity, resting SBP and height were significant predictors of the workload-indexed SBP parameters and were included in the reference equations. These novel reference values can aid clinicians and exercise physiologists in interpreting the SBP response to exercise and may provide a basis for future research on the prognostic impact of exercise SBP. In females, a markedly higher SBP in relation to workload could imply a greater peripheral vascular resistance during exercise than in males.
Highlights
Systolic blood pressure (SBP) is measured routinely during clinical exercise testing and abnormal systolic blood pressure (SBP) responses are predictive of underlying1 as well as future2,3 cardiovascular disease
Upper and lower limits of normal for all SBP measures per sex and age groups are available in Appendix 1
Using strict selection criteria from a large clinical exercise-testing database, cross-linked with nationwide registries, this study present unique age- and sex-specific upper limits of normality as well as reference equations for the workload-indexed SBP response to exercise in subjects without cardiovascular disease or comorbidities
Summary
Systolic blood pressure (SBP) is measured routinely during clinical exercise testing and abnormal SBP responses are predictive of underlying as well as future cardiovascular disease. Depending on the population studied, higher as well as lower peak SBP values at exercise testing have been found to be associated with cardiovascular and all-cause mortality, and there is currently no consensus on the normal SBP response to exercise.. Several studies present upper limits for peak SBP, stratified by sex and age groups, they offer little guidance on how to account for workload in evaluating the SBP response.. Several studies present upper limits for peak SBP, stratified by sex and age groups, they offer little guidance on how to account for workload in evaluating the SBP response.18–20 This may be of importance as recent data suggest that a steeper increase in SBP in relation to workload is a stronger prognostic factor of mortality than peak SBP alone.. Guidelines recommend considering workload in interpretation of the systolic blood pressure (SBP) response to exercise, but reference values are lacking. A markedly higher SBP in relation to workload could imply a greater peripheral vascular resistance during exercise than in males
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