The physiologic response to exercise may provide valuable prognostic information. We investigated the association of blood pressure (BP) measurements during exercise stress testing (EST) with long-term risk of myocardial infarction, stroke or death (major adverse cardiovascular event, MACE), as well as the development of new-onset hypertension.Methods: A retrospective analysis of treadmill ESTs (years 2005ESTs (years -2019 performed by the Bruce protocol in patients aged 35-75 years without a history of cardiovascular disease (n ¼ 14 792; 48% women). BP was documented at rest, submaximal exercise (Bruce stage-2), peak exercise and recovery (2 min). Association of SBP measures with study outcomes during median follow-up of 6.5 years was investigated.Results: Highest vs. lowest SBP quartile at rest (!140 vs. <120 mmHg), submaximal-exercise (!170 vs. <130 mmHg), peak-exercise (!180 vs. 145 mmHg) and recovery (!160 vs. <130 mmHg) was associated with an increase in the adjusted hazard ratio and 95% confidence interval (CI) for MACE: 1.53 (1. 23-1.88), 1.33 (1.01-1.76), 1.30 (1.05-1.61), 1.35 (1.09-1.68), respectively. The association between SBP at submaximal exercise and recovery with MACE displayed a J-shaped pattern. Among nonhypertensive patients (n ¼ 8529), excessive SBP response to peak exercise (!190 mmHg in women and !210 mmHg in men) was an independent predictor of hypertension [hazard ratio (95% CI)]: 1.87 (1.41-2.48), as were SBPs during submaximal exercise [>160 vs. 130 mmHg: 2.44 (1.97-3.03)] and recovery [!140 vs. 120 mmHg: 1.65 (1.37-1.98)]. Conclusion: BP measurement during rest, exercise and recovery phases of EST provides incremental prognostic information regarding long-term risk for cardiovascular events and the probability for developing hypertension.