Abstract
Exaggerated blood pressure responses (EBPR) during exercise are associated with increased risk of mortality. Due to the prognostic value of EBPR, it is important to evaluate the reliability of criteria used to define this response. PURPOSE: This study assessed the test-retest reliability of two different criteria used to define EBPR: the maximal systolic blood pressure (SBP) and the SBP/METs-slope which is the ratio of the change in SBP to the change in the metabolic equivalents of task (METs). METHODS: Twenty healthy, normotensive adults (8 males: 21±1 years, 12 females: 21±1 years) completed two identical modified Bruce treadmill tests on separate days. Blood pressure was measured using an automated motion-tolerant auscultatory device at rest (i.e., standing on treadmill) and during the last minute of each exercise stage. For each test, maximal SBP was identified, METs were estimated, and the change in these indices (i.e., maximal – rest) were calculated to determine the SBP/METs-slope. Test-retest reliability of the two criteria were assessed using intraclass correlation coefficients (ICC), with an ICC > 0.60 considered reliable. RESULTS: Total exercise time was similar between visits (1000±123 s vs. 1005±128 s, P=0.33). Reliability of the EBPR criteria are presented as (ICC; 95% confident intervals). Maximal SBP (0.45; 0.02-0.74) and SBP/METs-slope (0.29; -0.16-0.64) were not reliable. Participants were then separated based on sex. In males, maximal SBP (0.85; 0.44-0.97) was reliable while the SBP/METs-slope only demonstrated moderate reliability (0.59; -0.13-0.90). In females, both maximal SBP and the SBP/METs-slope were not reliable (ICCs <0.17). Using the criteria of a maximal SBP ≥210 and ≥190 mmHg for males and females respectively, 50% of males and 33% of females had EBPR on both visits. CONCLUSION: Criteria used to define EBPR are only reliable in males. Further investigation is warranted to understand the potential sex effects on the SBP responses to maximal exercise testing.
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