This study was designed to assess the clinical usefulness of an exaggerated blood pressure ( BP ) response to exercise in predicting the development of sustained hypertension in a population of healthy subjects with normal and high-normal BP values at rest. We examined a population of 246 Italian Air Force officers ( aged 49.5 ± 4.6 years ) who underwent a bycicle ergometer exercise testing at baseline and then were followed for 52.2 ± 14 months. At entry 45 patients ( 18.3 % GROUP A ) showed an exaggerated blood pressure response to exercise ( systolic BP ≥ 210 mmHg and/or diastolic BP ≥ 105 mmHg at maximum work load), while 201 patients ( 81.7 % GROUP B ) had a normal pressure response. No significant difference was found at entry between the two groups regarding age, family history of hypertension or cardiovascular disease, body mass index, smoking habit, exercise tolerance and metabolic abnormalities. All patients underwent a bycicle exercise test with a load increase of 25 Watt every two minutes, until exhaustion or until they reached 85 % of their maximal predictable heart rate. No significant difference was found between the two groups concerning maximum work load and exercise duration as well as baseline and maximum heart rate. Patients of group A showed a significantly higher systolic and diastolic blood pressure at maximum work load ( 214.3 ± 15.2 versus 187.5 ± 17.8 and 108.3 ± 10.1 versus 83.8 ± 7.1 respectively ). At the end of follow-up period 30 patients belonging to group A ( 66.7 %) and 33 patients belonging to group B ( 16.4 % ) had developed sustained hypertension and were treated either with beta-blockers or ACE inhibitors. These results seem to suggest the idea that an exaggerated response to exercise represents an important risk factor for new-onset hypertension from high-normal state and might improve the prediction of the need for antihypertensive medication in subjects with high-normal values at rest.