Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry

Abstract

Background Guidelines recommend considering workload in interpretation of the systolic blood pressure (SBP) response to exercise, but reference values are lacking. Design This was a retrospective, consecutive cohort study. Methods From 12,976 subjects aged 18–85 years who performed a bicycle ergometer exercise test at one centre in Sweden during the years 2005–2016, we excluded those with prevalent cardiovascular disease, comorbidities, cardiac risk factors or medications. We extracted SBP, heart rate and workload (watt) from ≥ 3 time points from each test. The SBP/watt-slope and the SBP/watt-ratio at peak exercise were calculated. Age- and sex-specific mean values, standard deviations and 90th and 95th percentiles were determined. Reference equations for workload-indexed and peak SBP were derived using multiple linear regression analysis, including sex, age, workload, SBP at rest and anthropometric variables as predictors. Results A final sample of 3839 healthy subjects ( n = 1620 female) were included. While females had lower mean peak SBP than males (188 ± 24 vs 202 ± 22 mmHg, p < 0.001), workload-indexed SBP measures were markedly higher in females; SBP/watt-slope: 0.52 ± 0.21 versus 0.41 ± 0.15 mmHg/watt ( p < 0.001); peak SBP/watt-ratio: 1.35 ± 0.34 versus 0.90 ± 0.21 mmHg/watt ( p < 0.001). Age, sex, exercise capacity, resting SBP and height were significant predictors of the workload-indexed SBP parameters and were included in the reference equations. Conclusions These novel reference values can aid clinicians and exercise physiologists in interpreting the SBP response to exercise and may provide a basis for future research on the prognostic impact of exercise SBP. In females, a markedly higher SBP in relation to workload could imply a greater peripheral vascular resistance during exercise than in males.

(Hypertension and sports)

“…Stejný kolektiv pak nedávno publikoval i nové regresní rovnice pro výpočet příslušných hodnot TK v zátěži. 16 Podobné normy pak byly publikovány i pro americkou populaci v rámci projektu FRIEND. 17 Nadměrná tlaková reakce na zátěž může také souviset s výskytem maskované hypertenze.…”

Rays of light into the ‘black-box’ of exercise hypertension

“…The authors speculate that the markedly higher SBP in relation to workload in women could be the result of a greater peripheral vascular resistance during exercise as compared to men. 13 With this study the authors contribute helpful and urgently needed results with respect to the determination of threshold values to define exaggerated exercise SBP using workload-indexed SBP parameters. Nevertheless, it is necessary to point out various limitations of this study.…”

“…Against this background and taking into account our insufficient knowledge concerning exerciseinduced BP, the study of Hedman et al 13 published in this issue is of high importance. Hedman et al 13 published age and gender-specific upper limits and reference equations for the workload-indexed SBP response during bicycle ergometry.…”

“…Against this background and taking into account our insufficient knowledge concerning exerciseinduced BP, the study of Hedman et al 13 published in this issue is of high importance. Hedman et al 13 published age and gender-specific upper limits and reference equations for the workload-indexed SBP response during bicycle ergometry. The aim of this retrospective, consecutive cohort study was to provide normative data on the slope of SBP increase per Watt increment (SBP/Watt slope), as well as on the ratio of SBP and Watt at peak exercise.…”

“…Furthermore, the gender-specific findings should be investigated in future studies. In summary, Hedman et al 13 have carried out valuable groundwork in the difficult field of BP regulation under physical exercise.…”