Exaggerated blood pressure response to exercise: importance of resting blood pressure

Normotensive individuals who exhibit an exaggerated blood pressure (BP) response to exercise have an increased risk of future hypertension. However, previous studies failed to control for resting BP despite the fact that an elevated resting BP in the normotensive range is also a strong predictor of future hypertension. Therefore, we determined whether maximal systolic BP is associated with resting BP. Resting BP was measured in 68 healthy normotensive men on three separate days. The subjects then performed a graded, maximal exercise test on a Monark cycle ergometer. Maximal systolic BP was strongly correlated with resting systolic BP (r = 0.64, P < 0.0001). Subjects with elevations in systolic BP during maximal exercise (> 220 mmHg) also had higher (P < 0.005) resting BP than those without (< 220 mmHg). When stepwise regression analyses were performed, systolic BP at rest was a significant independent predictor of maximal systolic BP, explaining over 40% of the variability. These results suggest that exaggerated BP response as a predictor of future hypertension reported in previous studies may be little more than a simple reflection of elevated resting BP. Specifically, these studies should not be interpreted as demonstrating that exercise BP is a better predictor of future hypertension than resting BP alone. In the future, defining the BP 'response' to exercise as a change score (i.e. maximal BP minus resting BP) may be advantageous as it permits the effects of exercise to be examined independently of the level of resting BP.