Associations Between Exercise Blood Pressure Responses and Oxygen Pulse During Cardiopulmonary Exercise Testing: A...

To observe the impact of exaggerated blood pressure response during exercise on oxygen pulse (O₂pulse), facilitating earlier and more precise identification of the subclinical threat of hypertension.

This cross-sectional study consecutively enrolled 262 patients with exaggerated blood pressure response (EBPR) (March 2023-March 2025). Based on peak O₂pulse ≥80% of predicted value, patients were divided into Normal (n=149) and Reduced O₂pulse (n=113) groups. Baseline characteristics, laboratory findings, and CPET parameters were collected. Binary logistic regression analysis was used to identify independent factors associated with reduced peak O₂pulse ratio. Multiple linear regression models were employed with the relative increase of O₂pulse before and after the anaerobic threshold (AT) as dependent variables to explore the associations of blood pressure increase and metabolic equivalent (MET)-adjusted blood pressure increase with changes in O₂pulse relative increase.

Compared with the Normal O₂pulse group, the Reduced O₂pulse group had a higher proportion of males, younger age, higher BMI, and worse metabolic profiles. Logistic regression identified advanced age and alcohol consumption as independent risk factors for reduced peak O₂pulse, while female sex was protective. Regarding blood pressure, unadjusted SBP increase correlated positively with peak O₂pulse ratio and O₂pulse relative increase, whereas MET‑adjusted SBP increase showed a significant negative correlation with both. This inverse association suggests that an exaggerated blood pressure response per unit metabolic demand is linked to compromised cardiac pumping efficiency.

The negative correlation between ΔSBP/MET and O₂pulse suggests that an exaggerated blood pressure response may come at the cost of compromised cardiac pumping efficiency. An excessively high ΔSBP/MET value often indicates more significant changes in the structure and function of the heart, and is an aspect that requires particular attention in the future.