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<p>Exaggerated systolic blood pressure (SBP) during submaximal exercise is associated with increased cardiovascular (CV) risk. However, findings are mixed and new evidence indicates that cardiorespiratory fitness should be considered for proper clinical interpretation of exercise SBP responses. This study aimed to determine the relationship between exercise SBP during submaximal effort corrected and uncorrected for fitness, as well as at peak effort and abnormalities of cardiac structure and function. Each of 231 participants with controlled BP (with or without previously diagnosed hypertension), no evidence for ischemic or valvular heart disease, or heart failure underwent cardiopulmonary exercise testing and resting and exercise echocardiography. Submaximal exercise SBP (measured at the 2<sup>nd</sup> stage of Bruce protocol) and peak exercise SBP was corrected for peak VO<sub>2</sub>. Associations with TOD – target organ damage (left ventricular [LV] mass, relative wall thickness, diastolic function, LV exercise reserve) were stronger for fitness-corrected than uncorrected exercise SBP. There was a progressive deterioration of cardiac function and structure parameters across the submaximal exercise SBP/peak VO<sub>2</sub> tertiles. Multivariable models demonstrated that fitness-corrected SBP was more closely associated with LV hypertrophy and diastolic dysfunction than uncorrected SBP, and ROC analysis revealed better performance of fitness-corrected SBP than uncorrected SBP (AUC 0.792 vs. 0.627, and 0.808 vs. 0.662, both p &lt; 0.001, for LV hypertrophy and diastolic dysfunction, respectively). Fitness-corrected SBP responses to submaximal exercise can identify more profound target organ damage with respect to cardiac function and structure even among patients with controlled clinic BP. Exaggerated BP response to exercise must be considered relative to fitness for proper clinical interpretation of BP responses to exercise testing.</p>

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Exaggerated blood pressure response to submaximal exercise and cardiac target organ damage: importance of fitness

  • 期刊论文

  • 发表日期：

    2025年10月15日

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  • Jowita Zachwyc,
  • James E. Sharman,
  • Wojciech Kosowski,
  • Anna K. Woznicka,
  • Tomasz Kotwica,
  • Grzegorz Kubielas,
  • Monika Przewlocka-Kosmala,
  • Wojciech Kosmala

摘要

Exaggerated systolic blood pressure (SBP) during submaximal exercise is associated with increased cardiovascular (CV) risk. However, findings are mixed and new evidence indicates that cardiorespiratory fitness should be considered for proper clinical interpretation of exercise SBP responses. This study aimed to determine the relationship between exercise SBP during submaximal effort corrected and uncorrected for fitness, as well as at peak effort and abnormalities of cardiac structure and function. Each of 231 participants with controlled BP (with or without previously diagnosed hypertension), no evidence for ischemic or valvular heart disease, or heart failure underwent cardiopulmonary exercise testing and resting and exercise echocardiography. Submaximal exercise SBP (measured at the 2nd stage of Bruce protocol) and peak exercise SBP was corrected for peak VO2. Associations with TOD – target organ damage (left ventricular [LV] mass, relative wall thickness, diastolic function, LV exercise reserve) were stronger for fitness-corrected than uncorrected exercise SBP. There was a progressive deterioration of cardiac function and structure parameters across the submaximal exercise SBP/peak VO2 tertiles. Multivariable models demonstrated that fitness-corrected SBP was more closely associated with LV hypertrophy and diastolic dysfunction than uncorrected SBP, and ROC analysis revealed better performance of fitness-corrected SBP than uncorrected SBP (AUC 0.792 vs. 0.627, and 0.808 vs. 0.662, both p < 0.001, for LV hypertrophy and diastolic dysfunction, respectively). Fitness-corrected SBP responses to submaximal exercise can identify more profound target organ damage with respect to cardiac function and structure even among patients with controlled clinic BP. Exaggerated BP response to exercise must be considered relative to fitness for proper clinical interpretation of BP responses to exercise testing.