Blood pressure response to graded bicycle exercise in males and females across the age and fitness spectrum

Journal article

Janssens, Kristel, Foulkes, Stephen J., Mitchell, Amy M., Dausin, Christophe, Van Soest, Sofie, Spencer, Luke, Rowe, Stephanie J., D'Ambrosio, Paolo, Elliott, Adrian D., Van Puyvelde, Tim, Parr, Evelyn B., Willems, Rik, Heidbuchel, Hein, Claessen, Guido and La Gerche, Andre. (2025). Blood pressure response to graded bicycle exercise in males and females across the age and fitness spectrum. European Journal of Preventative Cardiology. 32(1), pp. 43-51. https://doi.org/10.1093/eurjpc/zwae262
AuthorsJanssens, Kristel, Foulkes, Stephen J., Mitchell, Amy M., Dausin, Christophe, Van Soest, Sofie, Spencer, Luke, Rowe, Stephanie J., D'Ambrosio, Paolo, Elliott, Adrian D., Van Puyvelde, Tim, Parr, Evelyn B., Willems, Rik, Heidbuchel, Hein, Claessen, Guido and La Gerche, Andre
Abstract

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

Keywordsathlete; exercise; hypertension; sex differences; workload-indexed
Year2025
JournalEuropean Journal of Preventative Cardiology
Journal citation32 (1), pp. 43-51
PublisherOxford University Press
ISSN2047-4881
Digital Object Identifier (DOI)https://doi.org/10.1093/eurjpc/zwae262
PubMed ID39116385
Scopus EID2-s2.0-85214854895
Open accessPublished as ‘gold’ (paid) open access
Page range43-51
FunderResearch Training Program Scholarship (RTP), Australian Government
Research Foundation Flanders (FWO)
National Health and Medical Research Council (NHMRC)
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online08 Aug 2024
Publication process dates
Accepted30 Jul 2024
Deposited04 Jun 2025
Supplemental file
License
File Access Level
Open
Grant IDAPP2027105
Additional information

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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