From the Guidelines
An excessive blood pressure response during exercise is defined as a maximal systolic blood pressure value of ≥210 mm Hg for men and ≥190 mm Hg for women, as well as a rise in diastolic blood pressure of >10 mm Hg above the resting value or an absolute value of 90 mm Hg. Specifically:
- For systolic blood pressure: A maximal value of ≥210 mm Hg for men and ≥190 mm Hg for women is considered excessive, as indicated by the American Heart Association 1.
- For diastolic blood pressure: A rise of >10 mm Hg above the resting value or an absolute value of 90 mm Hg is considered abnormal and could predict increased likelihood of CAD, according to the American Heart Association 1. It's essential to note that an exaggerated systolic blood pressure response to exercise could indicate an increased risk for future hypertension, LV hypertrophy, and cardiovascular events, as reported in the study published in Circulation 1. If an excessive blood pressure response is observed during an exercise test, the test should be terminated when systolic or diastolic blood pressure exceeds 250 and 115 mm Hg, respectively, as recommended by the American Heart Association 1. This excessive response is concerning because it suggests the cardiovascular system is not adapting efficiently to increased physical demands, which could lead to complications during everyday activities or more strenuous exercise. Key considerations for exercise test termination include:
- Systolic blood pressure of >250 mm Hg
- Diastolic blood pressure of >115 mm Hg
- Failure of systolic blood pressure to fall or a rise in the short-term recovery period, relative to the maximal exercise value, which has been shown to be predictive of an increased risk of death, as indicated by the study published in Circulation 1.
From the Research
Definition of Excessive Blood Pressure Response
- An excessive blood pressure response during exercise is defined as a systolic blood pressure ≥210 mm Hg in men or ≥190 mm Hg in women, or a diastolic blood pressure ≥110 mm Hg in men or women 2.
- Alternatively, an exaggerated blood pressure response (EBPR) during exercise can be defined as a diastolic blood pressure of more than 95 mm Hg at peak exercise or a systolic pressure of more than 180 mm Hg at moderate exercise 3.
Predictors of Excessive Blood Pressure Response
- Resting systolic blood pressure and cardiorespiratory fitness are determinants of a submaximal exercise blood pressure response for both hypertensive and normotensive women 4.
- Low cardiorespiratory fitness is associated with a higher blood pressure response during submaximal exercise, suggesting that increased fitness may attenuate this abnormal rise in blood pressure 4.
- Age, body mass index, resting systolic and diastolic blood pressure, heart rate, and exercise time to exhaustion are also significant associations with the 6-minute exercise blood pressure 4.
Clinical Significance of Excessive Blood Pressure Response
- An excessive blood pressure response during exercise is associated with an increased propensity for target organ damage and predicts the future development of hypertension, cardiovascular events, and mortality, independent of resting blood pressure 2.
- Exaggerated exercise blood pressure carries elevated cardiovascular disease risk due to its association with sub-clinical hypertension 5.
- Both exercise hypotension and exaggerated exercise blood pressure serve as markers that should prompt evaluation for potential underlying cardiovascular disease 5.
Thresholds for Excessive Blood Pressure Response
- There is no consensus definition of excessive blood pressure response during exercise, and the current guidelines lack empirical evidence to support the normal blood pressure responses and their upper limits 6.
- Different studies have proposed different thresholds for excessive blood pressure response, highlighting the need for further research to determine the optimal thresholds 3, 6, 4.