Exercise Blood Pressure Guidelines: Time to Re-evaluate What is Normal and Exaggerated?
Abstract
Blood pressure responses to graded exercise testing can provide important diagnostic and prognostic information. While published guidelines outline what constitutes a "normal" and "abnormal" (i.e., exaggerated) blood pressure response to exercise testing, the widespread use of exaggerated blood pressure responses as a clinical tool is limited due to sparse and inconsistent data. A review of the original sources from these guidelines reveals an overall lack of empirical evidence to support both the normal blood pressure responses and their upper limits. In this current opinion, we critically evaluate the current exercise blood pressure guidelines including (1) the normal blood pressure responses to graded exercise testing; (2) the upper limits of this normal response; (3) the blood pressure criteria for test termination; and (4) the thresholds for exaggerated blood pressure responses. We provide evidence that exercise blood pressure responses vary according to subject characteristics, and subsequently a re-evaluation of what constitutes normal and abnormal responses is necessary to strengthen the clinical utility of this assessment.
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A lack of workload standardization is a methodological consideration that perhaps contributes toward uncertainties surrounding the clinical value of EEBP.
“Alack of workload standardization is a methodological consideration that perhaps contributes toward the uncertainties surrounding the clinical value EEBP (24,37).”
From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [24]
The normal rate of SBP increase during exercise testing varies with age and sex, ranging from approximately 5 to 8 mm Hg per MET, and is less steep in females and healthy young people.
“As discussed by Currie et al. (24), the normal rate of SBP increase (represented by the middle lines in each panel of Fig. 2) will vary based on several factors including age and sex (ranging from ~5 to 8 mm Hg·MET -1 , being less steep in females and healthy young).”
From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as Currie et al. (24)
There is a lack of clarity regarding exact thresholds above which exaggerated exercise blood pressure denotes increased cardiovascular disease risk.
“Notwithstanding a lack of clarity regarding exact thresholds above which denotes increased CVD risk related to EEBP (24)”
From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [24]
Clinical data outlined in this review imply that blood pressure recorded during submaximal exercise may hold the most clinically relevant information about high blood pressure and cardiovascular disease risk.
“Notwithstanding a lack of clarity regarding exact thresholds above which denotes increased CVD risk related to EEBP (24), the clinical data outlined in this review imply that BP recorded during submaximal exercise may hold the most clinically relevant information about high BP and CVD risk.”
From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [24]
The rate of systolic BP increase during exercise varies based on age, sex, ethnicity, cardiorespiratory fitness, and overall health status.
“The rate of systolic BP increase will vary based on age, sex, ethnicity, cardiorespiratory fitness, and overall health status [14].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [14]
There is currently a lack of consensus around a threshold of exercise BP that denotes increased CVD risk.
“There is currently a lack of consensus around a threshold of exercise BP that denotes increased CVD risk [14].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [14]
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“Notwithstanding a lack of clarity regarding exact thresholds above which denotes increased CVD risk related to EEBP (24), the clinical data outlined in this review imply that BP recorded during submaximal exercise may hold the most clinically relevant information about high BP and CVD risk.”
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Self-citation
- Authors
- Currie, K. D., Floras, J. S., La Gerche, A., & Goodman, J. M.
- Affiliations
- University of Toronto (CA)
- Mount Sinai Hospital (CA)
- Corresponding author
- Goodman, Jack M.
- Venue
- Sports Medicine
- Published
- 2018-03-24
- Volume
- 48
- Issue
- 8
- Pages
- 1763-1771
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- OpenAlex
- W2791651485
- Cited by
- 68
- References
- 66
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 12 · 2023: 4 · 2022: 14 · 2021: 8 · 2020: 10 · 2019: 3 · 2018: 1
- FWCI
- 7.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (MFE-140863)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- blood pressure response to exercise, incremental exercise test, exaggerated blood pressure response, blood pressure guidelines, test termination criteria, reference values, hypertension
- MeSH terms
- Blood Pressure, Exercise Test, Humans, Hypertension, Prognosis, Exercise
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