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<p>Exercise blood pressure (BP) metrics have been promoted as a means of identifying latent or mild hypertension in athletes. We evaluated the diagnostic accuracy of four exercise BP metrics to diagnose hypertension, defined by 24-h ambulatory BP monitoring (ABPM) as mean ≥130/80 mmHg, daytime ≥135/85 mmHg and/or nighttime ≥120/70 mmHg. Fifty-four endurance-trained athletes (48 [IQR 24–58] years, 67% male) underwent exercise testing with serial BP measurements and 24-h ABPM. Exaggerated exercise BP (EEBP) was defined as exceeding a threshold for any of the four metrics: 1) maximal systolic BP (SBP<sub>max</sub>) using published cut-offs; SBP<sub>max</sub> ≥ 220 mmHg and ≥200 mmHg in males and females, respectively, 2) SBP/Workload-slope, 3) SBP<sub>max</sub>/Workload-ratio, 4) SBP at 2 Watts/kg. Receiver operating characteristic (ROC) curve analysis and Youden’s Index determined optimal cut-offs and diagnostic performance. Twelve of 54 (22%) athletes met criteria for hypertension. SBP<sub>max</sub> was reasonably sensitive for identifying hypertension (83% identified) but demonstrated poor specificity (62% of non-hypertensives misclassified), with an area under the ROC-curve (AUC) of 0.63. An EEBP cut-off of SBP &gt; 176 mmHg at 2 Watts/kg had the best diagnostic performance with 100% sensitivity, moderate specificity of 62%, and AUC of 0.79. Other metrics, incorporating exercise BP and workload, SBP<sub>max</sub>/Workload-ratio and SBP/Workload-slope, had moderate diagnostic utility (AUC = 0.71 and 0.67, respectively). In endurance athletes, exercise BP metrics demonstrated modest and variable diagnostic accuracy for identifying hypertension on 24-h ABPM. Assessment of SBP at a relative submaximal workload provided acceptable diagnostic accuracy while reducing overdiagnosis associated with published SBP<sub>max</sub> thresholds.</p><p></p>

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Diagnostic accuracy of different exercise blood pressure metrics in identifying hypertension on 24-h ambulatory blood pressure monitoring in athletes

  • 期刊论文

  • 发表日期：

    2025年10月22日

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  • Kristel Janssens,
  • Stephen J. Foulkes,
  • Paolo D’Ambrosio,
  • Amy M. Mitchell,
  • Stephanie J. Rowe,
  • Youri Bekhuis,
  • Luke Spencer,
  • Evelyn B. Parr,
  • Geoffrey A. Head,
  • Hein Heidbuchel,
  • Guido Claessen,
  • Andre La Gerche

摘要

Exercise blood pressure (BP) metrics have been promoted as a means of identifying latent or mild hypertension in athletes. We evaluated the diagnostic accuracy of four exercise BP metrics to diagnose hypertension, defined by 24-h ambulatory BP monitoring (ABPM) as mean ≥130/80 mmHg, daytime ≥135/85 mmHg and/or nighttime ≥120/70 mmHg. Fifty-four endurance-trained athletes (48 [IQR 24–58] years, 67% male) underwent exercise testing with serial BP measurements and 24-h ABPM. Exaggerated exercise BP (EEBP) was defined as exceeding a threshold for any of the four metrics: 1) maximal systolic BP (SBPmax) using published cut-offs; SBPmax ≥ 220 mmHg and ≥200 mmHg in males and females, respectively, 2) SBP/Workload-slope, 3) SBPmax/Workload-ratio, 4) SBP at 2 Watts/kg. Receiver operating characteristic (ROC) curve analysis and Youden’s Index determined optimal cut-offs and diagnostic performance. Twelve of 54 (22%) athletes met criteria for hypertension. SBPmax was reasonably sensitive for identifying hypertension (83% identified) but demonstrated poor specificity (62% of non-hypertensives misclassified), with an area under the ROC-curve (AUC) of 0.63. An EEBP cut-off of SBP > 176 mmHg at 2 Watts/kg had the best diagnostic performance with 100% sensitivity, moderate specificity of 62%, and AUC of 0.79. Other metrics, incorporating exercise BP and workload, SBPmax/Workload-ratio and SBP/Workload-slope, had moderate diagnostic utility (AUC = 0.71 and 0.67, respectively). In endurance athletes, exercise BP metrics demonstrated modest and variable diagnostic accuracy for identifying hypertension on 24-h ABPM. Assessment of SBP at a relative submaximal workload provided acceptable diagnostic accuracy while reducing overdiagnosis associated with published SBPmax thresholds.