Blood pressure response to graded bicycle exercise in males and females across the age and fitness spectrum
Open accessAbstract
Aims: Blood pressure (BP) responses to exercise are frequently measured, with the concern that greater increases are a marker of disease. We sought to characterize the normal exercise BP response in healthy adults and its relationships with age, sex, and fitness. Methods and results: Five hundred and eighty-nine participants [median age 46 (interquartile range 24–56) years, 81% male] underwent cardiopulmonary exercise testing with repeated, automated BP measures. An exaggerated maximal systolic BP (SBPmax) was defined from current guidelines as ≥210 mmHg in males and ≥190 mmHg in females. Individual linear regression analyses defined the relationship between BP and workload (W; SBP/W-slope and DBP/W-slope). Participants with or without an exaggerated SBPmax and above- or below-median SBP/W-slope were compared. An exaggerated SBPmax was found in 51% of males and 64% of females and was more prevalent in endurance-trained athletes (males 58%, females 72%, P < 0.001). The mean SBP/W-slope was lower in males (0.24 ± 0.10 mmHg/W) than females (0.27 ± 0.12 mmHg/W, P = 0.031). In both sexes, peak oxygen uptake (VO2peak) was inversely correlated with SBP/W-slope (P < 0.01). Those with an exaggerated SBPmax and below-median SBP/W-slope were 10 years younger and had a 20% higher VO2peak, on average (P < 0.001). A non-exaggerated SBPmax and above-median SBP/W-slope was observed in older individuals with the lowest VO2peak. Conclusion: In a large cohort of healthy individuals, an exaggerated SBPmax was common and associated with higher fitness. In contrast, higher SBP indexed to W was associated with older age, lower fitness, and female sex. Thus, sex, age, and fitness should be considered when evaluating BP response to exercise. Registration: Pro@Heart: NCT05164328, ACTRN12618000716268; ProAFHeart: ACTRN12618000711213; Master@Heart: NCT03711539
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There is a high prevalence of a hypertensive BP response when defined using a fixed systolic threshold.
“given the high prevalence of a hypertensive BP response when defined using a fixed systolic threshold,31”
From Resting and exercise-induced occult hypertension and coronary atherosclerosis in male masters endurance athletes (2026) · cites this paper as [31]
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- Authors
- Janssens, K., Foulkes, S. J., Mitchell, A. M., Dausin, C., Van Soest, S., Spencer, L., Rowe, S. J., D’Ambrosio, P., Elliott, A. D., Van Puyvelde, T., Parr, E. B., Willems, R., Heidbuchel, H., Claessen, G., & La Gerche, A.
- Affiliations
- St Vincents Institute of Medical Research (AU)
- University of Alberta (CA)
- KU Leuven (BE)
- Department of Cardiology, UZ Leuven , Leuven ,
- The University of Melbourne (AU)
- Royal Adelaide Hospital (AU)
- Heart, Exercise and Research Trials (HEART) Lab, St. Vincent’s Institute of Medical Research , 9 Princes Street, Fitzroy, Melbourne, VIC 3065 ,
- Australian Catholic University (AU)
- Universitair Ziekenhuis Leuven (BE)
- Department of Cardiovascular Sciences, University of Antwerp , Antwerp ,
- Hasselt University (BE)
- Corresponding author
- Janssens, Kristel
- ORCID
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-08-08
- Volume
- 32
- Issue
- 1
- Pages
- 43-51
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W4401447186
- Cited by
- 25
- References
- 32
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 1
- FWCI
- 12.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Preventive Cardiology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Document Server@UHasselt (UHasselt) (submittedVersion, cc-by)
- Lirias (submittedVersion, cc-by)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Funders
- Australian Government Research Training Program Scholarship
- Fund for Scientific Research Flanders
- National Health and Medical Research Council of Australia Investigator Grant (APP 2027105)
- 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, systolic blood pressure, sex differences, age differences, cardiorespiratory fitness, peak oxygen uptake, endurance athletes, healthy adults, reference values, older adults, sex differences in hypertension risk
- MeSH terms
- Cardiorespiratory Fitness, Adult, Age Factors, Bicycling, Blood Pressure, Exercise Test, Female, Humans, Male, Middle Aged, Physical Fitness, Sex Factors, Young Adult
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