What defines a hypertensive response to exercise during treadmill stress testing?

From the Guidelines

A hypertensive response to exercise during treadmill stress testing is typically defined as a systolic blood pressure exceeding 210 mmHg for men or 190 mmHg for women. This definition is based on the most recent and highest quality study available, which emphasizes the importance of monitoring blood pressure responses during exercise to identify potential cardiovascular risks 1. The criteria for a hypertensive response to exercise also include a rise in diastolic blood pressure during exercise of >10 mm Hg above the resting value or an absolute value of 90 mm Hg, as indicated in the study published in Circulation 1. Key points to consider when evaluating a hypertensive response to exercise include:

• The maximal value of systolic blood pressure during exercise
• The change in diastolic blood pressure from resting to exercise
• The presence of other cardiovascular risk factors
• The need for further evaluation and monitoring of patients who exhibit a hypertensive response to exercise, as it may indicate underlying issues with blood pressure regulation that aren't apparent at rest 1. It's essential to prioritize the single most recent and highest quality study when making a definitive recommendation, and in this case, the study from 2013 provides the most relevant and reliable information on the criteria for a hypertensive response to exercise during treadmill stress testing 1.

From the Research

Definition of Hypertensive Response to Exercise

A hypertensive response to exercise during treadmill stress testing is defined by various studies as:

• A peak systolic blood pressure (SBP) ≥ 190 mmHg in women and ≥ 210 mmHg in men 2
• A systolic blood pressure response corrected by the estimated metabolic equivalent (MET) ≥ 11.3 mmHg/MET 3
• An exaggerated blood pressure response (EBPR) to exercise stress testing, which may be a marker of future hypertension and carry valuable information for the prediction of cardiovascular events 4

Criteria for Hypertensive Response

The criteria for a hypertensive response to exercise include:

• SBP ≥ 140 mmHg at rest, ≥ 170 mmHg at submaximal exercise, ≥ 180 mmHg at peak exercise, and ≥ 160 mmHg at recovery 2
• An increase in SBP ≥ 20 mmHg during exercise 5
• A peak systolic BP ≥ 220 mmHg during exercise 6

Risk Factors Associated with Hypertensive Response

Risk factors associated with a hypertensive response to exercise include:

• Middle-aged individuals (40-60 years old) 4
• Resting systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg 4
• Known arterial hypertension 4
• Current cigarette smoking 4
• Family history of premature coronary artery disease 4

Association with Cardiovascular Events

A hypertensive response to exercise has been associated with an increased risk of:

• Major adverse cardiovascular events (MACE) 2
• All-cause death and incident myocardial infarction (MI) 5
• Cardiovascular events and the development of new-onset hypertension 2, 4