Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry
Open accessAbstract
BACKGROUND: Guidelines recommend considering workload in interpretation of the systolic blood pressure (SBP) response to exercise, but reference values are lacking. DESIGN: This was a retrospective, consecutive cohort study. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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There is a strong association between workload (e.g., watts) and systolic BP.
“While it is acknowledged that the relative intensity will differ between individuals for a given fixed workload, there is a strong association between workload (e.g., watts) and systolic BP [46].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [46]
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- Authors
- Hedman, K., Lindow, T., Elmberg, V., Brudin, L., & Ekström, M.
- Affiliations
- Linköping University (SE)
- Lund University (SE)
- Landstinget i Kalmar län (SE)
- Corresponding author
- Hedman, Kristofer
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-03-10
- Volume
- 28
- Issue
- 12
- Pages
- 1360-1369
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W3010765960
- Cited by
- 73
- References
- 33
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 10 · 2023: 9 · 2022: 14 · 2021: 13 · 2020: 4
- FWCI
- 11.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Preventive Cardiology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- County Council of Östergötland, Sweden (LIO-822461)
- Scientific Committee of Blekinge County Council
- 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 › Physiology › Physical Activity and Health
- Keywords
- systolic blood pressure, blood pressure response to exercise, cycle ergometry, reference equations, age- and sex-specific reference values, systemic vascular resistance, healthy adults, heart rate
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Bicycling, Blood Pressure, Exercise Test, Female, Humans, Male, Middle Aged, Retrospective Studies, Cohort Studies, Workload, Ergometry, Young Adult
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