Reference Standards for Blood Pressure Response During Peak Exercise in Pediatric Patients with Structurally Normal
Konrad S Kutrzuba1, Alan P Wang2, Garett J Griffith3
1Northwestern Feinberg School of Medicine, 240 E Huron Street, Chicago, IL, 60611, USA. konrad.kutrzuba@northwestern.edu.
Pediatric Cardiology
|May 2, 2026
Summary
Establishing normal blood pressure (BP) response standards during exercise in children is crucial. This study provides age- and sex-specific reference ranges for pediatric cardiopulmonary exercise testing (CPET) BP, identifying higher BP in those with elevated Body Mass Index (BMI).
Area of Science:
- Cardiology
- Pediatric Exercise Physiology
Background:
- Hypertensive blood pressure (BP) response during exercise is a known risk factor for cardiovascular disease.
- Establishing normative data for exercise-induced BP in children is essential for accurate assessment.
Purpose of the Study:
- To establish reference standards for BP response during treadmill-based cardiopulmonary exercise testing (CPET) in children and adolescents with structurally normal hearts.
- To define normal, elevated, and hypertensive BP responses to exercise based on age and sex.
Main Methods:
- Retrospective analysis of 2,043 maximal effort Bruce protocol CPETs in patients aged 6-18 years without heart disease.
- Age- and sex-specific statistical analyses to determine BP percentiles at peak exercise.
- Comparison of characteristics (BMI, resting BP, maximal heart rate, aerobic capacity) across different BP response groups.
Main Results:
- Reference standards for systolic blood pressure (SBP) percentiles at peak exercise were established, showing similar responses in prepubescent males and females, with higher SBP in adolescent males.
- Individuals with elevated and hypertensive exercise BP responses exhibited higher Body Mass Index (BMI) and resting SBP.
- No significant differences in maximal heart rate or aerobic capacity were observed based on peak exercise SBP.
Conclusions:
- This study provides crucial reference standards for exercise BP response in pediatric and adolescent populations using the Bruce protocol.
- These findings lay the groundwork for future research into the prognostic significance of hypertensive exercise BP responses in children.
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