Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Characterization of the blood pressure response during cycle ergometer cardiopulmonary exercise testing in black and white men

Data from the Fitness Registry and Importance of Exercise: A National Database (FRIEND)

Abstract

It has been established that blacks have higher overall incidence and prevalence of hypertension compared to their white counterparts. However, the maximum blood pressure (BP) response of blacks to exercise has not been characterized. A total of 5996 apparently healthy men from the Fitness Registry and Importance of Exercise: A National Database (FRIEND) who underwent maximum cardiopulmonary exercise tests on a cycle ergometer were included in this analysis. Of these participants, 1245 (21%) self-identified as black while the remaining 4751 (79%) identified as white. All subjects had a respiratory exchange ratio (RER) of ā‰„1.0 and had no reports of cardiovascular or pulmonary disease. Systolic BP (BP) response to exercise was indexed according to increase in workload (SBP/MET-slope). Both racial groups were subdivided into age groups by decade. Black men had higher peak SBP and higher SBP/MET-slopes compared to white men across all age groups (pā€‰<ā€‰0.001). Resting SBP was not different between blacks and whites except within the 18ā€“29-year age group. The differences in peak SBP and SBP/MET-slope between age and race groups indicate that black men have an exaggerated BP response to exercise irrespective of resting BP values. Further investigation is warranted to determine the underlying mechanisms responsible and clinical implications for this exaggerated BP response to exercise.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Study flowchart.
Fig. 2: Blood pressure responses at rest and maximum exercise using a cycle ergometer in black and white men.

Similar content being viewed by others

References

  1. Guazzi M, Arena R, Halle M, Piepoli MF, Myers J, Lavie CJ. 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2016;133:e694ā€“711.

    ArticleĀ  Google ScholarĀ 

  2. Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, et al. EACPR/AHA Scientific Statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2012;126:2261ā€“74. http://circ.ahajournals.org/content/126/18/2261%5Cnhttp://circ.ahajournals.org//subscriptions/%5Cnhttp://circ.ahajournals.org/.

    ArticleĀ  Google ScholarĀ 

  3. Kokkinos P, Myers J. Exercise and physical activity: clinical outcomes and applications. Circulation. 2010;122:1637ā€“48.

    ArticleĀ  Google ScholarĀ 

  4. Schultz MG, La Gerche A, Sharman JE. Blood pressure response to exercise and cardiovascular disease. Curr Hypertens Rep. 2017;19:89. http://link.springer.com/10.1007/s11906-017-0787-1.

    ArticleĀ  Google ScholarĀ 

  5. Currie KD, Floras JS, La Gerche A, Goodman JM. Exercise blood pressure guidelines: time to re-evaluate what is normal and exaggerated? Sport Med. 2018;48:1763ā€“71. http://link.springer.com/10.1007/s40279-018-0900-x.

    ArticleĀ  Google ScholarĀ 

  6. Hedman K, Cauwenberghs N, Christle JW, Kuznetsova T, Haddad F, Myers J. Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality. Eur J Prev Cardiol [Internet]. 2019 Sep 30;2047487319877268. https://doi.org/10.1177/2047487319877268.

  7. Jae SY, Kurl S, Kunutsor SK, Franklin BA, Laukkanen JA. Relation of maximal systolic blood pressure during exercise testing to the risk of sudden cardiac death in men with and without cardiovascular disease. Eur J Prev Cardiol. 2019;2047487319880031. https://pubmed.ncbi.nlm.nih.gov/31604381/. [Epub ahead of print].

  8. Sabbahi A, Arena R, Kaminsky LA, Myers J, Phillips SA. Peak blood pressure responses during maximum cardiopulmonary exercise testing. Hypertension. 2018;71:229ā€“36. http://hyper.ahajournals.org/lookup/doi/10.1161/HYPERTENSIONAHA.117.10116.

    ArticleĀ  CASĀ  Google ScholarĀ 

  9. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137:e67ā€“492. 20 http://www.ncbi.nlm.nih.gov/pubmed/29386200.

    ArticleĀ  Google ScholarĀ 

  10. Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, et al. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation. 2017;136:e393ā€“423.

    ArticleĀ  Google ScholarĀ 

  11. Thomas SJ, Booth JN, Dai C, Li X, Allen N, Calhoun D, et al. Cumulative incidence of hypertension by 55 years of age in blacks and whites: the CARDIA Study. J Am Heart Assoc. 2018;7:e007988. http://www.ncbi.nlm.nih.gov/pubmed/29997132.

    CASĀ  PubMedĀ  PubMed CentralĀ  Google ScholarĀ 

  12. Keller K, Stelzer K, Ostad MA, Post F. Impact of exaggerated blood pressure response in normotensive individuals on future hypertension and prognosis: systematic review according to PRISMA guideline. Adv Med Sci. 2017;62:317ā€“29. http://ac.els-cdn.com.proxy.cc.uic.edu/S1896112617300159/1-s2.0-S1896112617300159-main.pdf?_tid=21dd363e-3c44-11e7-a5f5-00000aab0f27&acdnat=1495165078_fe250c8926dd4ccbe225bf9c00feadc5.

    ArticleĀ  Google ScholarĀ 

  13. Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE, et al. The importance of cardiorespiratory fitness in the United States: the need for a national registry: a policy statement from the american heart association. Circulation. 2013;127:652ā€“62.

    ArticleĀ  Google ScholarĀ 

  14. Kaminsky LA, Arena R, Myers J. Reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing data from the fitness registry and the importance of exercise national database. Mayo Clin Proc. 2015;90:1515ā€“23. https://doi.org/10.1016/j.mayocp.2015.07.026.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  15. Kaminsky LA, Imboden MT, Arena R, Myers J. Reference Standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing using cycle ergometry: Data From the Fitness Registry and the Importance of Exercise National Database (FRIEND) Registry. Mayo Clin Proc. 2017;92:228ā€“33.

    ArticleĀ  Google ScholarĀ 

  16. Myers J, Arena R, Franklin B, Pina I, Kraus WE, McInnis K, et al. Recommendations for clinical exercise laboratories: a scientific statement from the american heart association. Circulation. 2009;119:3144ā€“61.

    ArticleĀ  Google ScholarĀ 

  17. Myers J, Forman DE, Balady GJ, Franklin BA, Nelson-Worel J, Martin B-JJ, et al. Supervision of exercise testing by nonphysicians: a scientific statement from the American Heart Association. Circulation. 2014;130:1014ā€“27.

    ArticleĀ  Google ScholarĀ 

  18. Arena R, Myers J, Kaminsky LA. Revisiting age-predicted maximal heart rate: can it be used as a valid measure of effort? Am Heart J. 2016;173:49ā€“56. https://doi.org/10.1016/j.ahj.2015.12.006.

    ArticleĀ  PubMedĀ  Google ScholarĀ 

  19. Sharman JE, LaGerche A. Exercise blood pressure: clinical relevance and correct measurement. J Hum Hypertens. 2015;29:351ā€“8. http://www.nature.com/articles/jhh201484.

  20. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: a scientific statement from the American heart association. Circulation. 2013;128:873ā€“934.

  21. Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366:321ā€“9. http://www.nejm.org/doi/pdf/10.1056/NEJMoa1012848.

    ArticleĀ  CASĀ  Google ScholarĀ 

  22. Abate NI, Mansour YH, Tuncel M, Arbique D, Chavoshan B, Kizilbash A, et al. Overweight and sympathetic overactivity in black Americans. Hypertension. 2001;38:379ā€“83. http://hyper.ahajournals.org/lookup/doi/10.1161/01.HYP.38.3.379.

    ArticleĀ  CASĀ  Google ScholarĀ 

  23. Bombelli M, Facchetti R, Sega R, Carugo S, Fodri D, Brambilla G, et al. Impact of body mass index and waist circumference on the long-term risk of diabetes mellitus, hypertension, and cardiac organ damage. Hypertension. 2011;58:1029ā€“35.

    ArticleĀ  CASĀ  Google ScholarĀ 

  24. Feairheller DL, Park J-Y, Sturgeon KM, Williamson ST, Diaz KM, Veerabhadrappa P, et al. Racial differences in oxidative stress and inflammation: in vitro and in vivo. Clin Transl Sci. 2011;4:32ā€“7.

    ArticleĀ  CASĀ  Google ScholarĀ 

  25. Kim K, Hurr C, Patik JC, Matthew Brothers R. Attenuated cutaneous microvascular function in healthy young African Americans: role of intradermal l-arginine supplementation. Microvasc Res. 2018;118:1ā€“6. https://www-sciencedirect-com.proxy.cc.uic.edu/science/article/pii/S0026286217302339.

  26. Melikian N, Wheatcroft SB, Ogah OS, Murphy C, Chowienczyk PJ, Wierzbicki AS, et al. Asymmetric Dimethylarginine and reduced nitric oxide bioavailability in young black African men. Hypertension. 2007;49:873ā€“7. http://hyper.ahajournals.org/cgi/doi/10.1161/01.HYP.0000258405.25330.80.

    ArticleĀ  CASĀ  Google ScholarĀ 

  27. Kalinowski L, Dobrucki IT, Malinski T. Race-specific differences in endothelial function predisposition of African Americans to vascular diseases. Circulation. 2004;109:2511ā€“7. http://www.circulationaha.org.

    ArticleĀ  Google ScholarĀ 

  28. Ozkor MA, Rahman AM, Murrow JR, Kavtaradze N, Lin J, Manatunga A, et al. Differences in vascular nitric oxide and endothelium-derived hyperpolarizing factor bioavailability in blacks and whites. Arterioscler Thromb Vasc Biol. 2014;34:1320ā€“7. http://atvb.ahajournals.org/lookup/suppl/doi:10.1161/ATVBAHA.113.303136/-/DC1.

    ArticleĀ  CASĀ  Google ScholarĀ 

  29. Vongpatanasin W, Wang Z, Arbique D, Arbique G, Adamsā€Huet B, Mitchell JH, et al. Functional sympatholysis is impaired in hypertensive humans. J Physiol. 2011;589:1209ā€“20. https://physoc-onlinelibrary-wiley-com.proxy.cc.uic.edu/doi/abs/10.1113/jphysiol.2010.203026.

    ArticleĀ  CASĀ  Google ScholarĀ 

  30. Heffernan KS, Jae SY, Wilund KR, Woods JA, Fernhall B. Racial differences in central blood pressure and vascular function in young men. Am J Physiol Circ Physiol. 2008;295:H2380ā€“7. http://www.physiology.org/doi/10.1152/ajpheart.00902.2008.

    ArticleĀ  Google ScholarĀ 

  31. Bond V, Stephens Q, Adams RG, Vaccaro P, Demeersman R, Williams D, et al. Aerobic exercise attenuates an exaggerated exercise blood pressure response in normotensive young adult African-American men. Blood Press. 2002;11:229ā€“34.

    ArticleĀ  Google ScholarĀ 

  32. Riebe D, Ehrman JK, Liguori G, Magal M, (eds) ACSMā€™s guidelines for exercise testing and prescription. 10th ed. Philadelphia, PA: Wolters Kluwer Health; 2018.

  33. Yan H, Ranadive SM, Heffernan KS, Lane AD, Kappus RM, Cook MD, et al. Hemodynamic and arterial stiffness differences between African-Americans and Caucasians after maximal exercise. Am J Physiol Circ Physiol. 2014;306:H60ā€“8. http://www.physiology.org/doi/10.1152/ajpheart.00710.2013.

    ArticleĀ  CASĀ  Google ScholarĀ 

  34. Barbosa TC, Kaur J, Stephens BY, Akins JD, Keller DM, Brothers RM, et al. Attenuated forearm vascular conductance responses to rhythmic handgrip in young African-American compared with Caucasian-American men. Am J Physiol Circ Physiol. 2018;315:H1316ā€“21. https://www.physiology.org/doi/10.1152/ajpheart.00387.2018.

    ArticleĀ  CASĀ  Google ScholarĀ 

  35. Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, et al. Clinicianā€™s guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation. 2010;122:191ā€“225. http://circ.ahajournals.org/cgi/content/long/122/2/191.

    ArticleĀ  Google ScholarĀ 

  36. Chant B, Bakali M, Hinton T, Burchell AE, Nightingale AK, Paton JFR, et al. Antihypertensive treatment fails to control blood pressure during exercise. Hypertension. 2018;72:102ā€“9.

    ArticleĀ  CASĀ  Google ScholarĀ 

  37. Schultz MG, Sharman JE. Exercise hypertension. Pulse. 2013;1:161ā€“76. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4315351&tool=pmcentrez&rendertype=abstract.

    ArticleĀ  Google ScholarĀ 

  38. Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S. Exercise blood pressure and future cardiovascular death in asymptomatic individuals. Circulation.2010;121:2109ā€“16. http://circ.ahajournals.org.

    ArticleĀ  Google ScholarĀ 

  39. Daida H, Allison TG, Squires RW, Miller TD, Gau GT. Peak exercise blood pressure stratified by age and gender in apparently healthy subjects. Mayo Clin Proc. 1996;71:445ā€“52.

    ArticleĀ  CASĀ  Google ScholarĀ 

Download references

Acknowledgements

FRIEND Consortium Contributors are as follows: Ball State University (Leonard Kaminsky, Matthew Harber), METTEST (Sundeep Chaudhry), Massachusetts General Hospital (Gregory Lewis). This study was supported in part by an NIH training grant to Ahmad Sabbahi (T32-HL-139439).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ahmad Sabbahi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisherā€™s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sabbahi, A., Arena, R., Kaminsky, L.A. et al. Characterization of the blood pressure response during cycle ergometer cardiopulmonary exercise testing in black and white men. J Hum Hypertens 35, 685ā€“695 (2021). https://doi.org/10.1038/s41371-020-00411-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-020-00411-5

Search

Quick links