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Reliability of blood pressure responses used to define an exaggerated blood pressure response to exercise in young healthy adults

Abstract

Exaggerated blood pressure (BP) responses (EBPR) to exercise are prognostic of future cardiovascular risk. The primary objective of this study was to assess the test–retest reliability of BP responses used to categorize EBPR as absent or present. Twenty-seven healthy adults [21(2) years; 12 males] with resting BP < 130/80 mmHg completed a modified Bruce protocol treadmill exercise test on two visits separated by 6 (3) days. BP measurements were obtained during exercise using an automated auscultatory device. Submaximal and maximal systolic and diastolic BP, the change in diastolic BP from rest to maximal diastolic BP, and the change in systolic BP relative to the change in exercise intensity, quantified using the metabolic equivalent of task (SBP/MET-slope) were determined. Test–retest reliability of these BP responses was assessed using intraclass correlation coefficients (ICC) with a value ≥0.61 considered as substantial reliability. Submaximal diastolic BP demonstrated substantial reliability in the total group (ICC = 0.670; P ≤ 0.001). In males, submaximal systolic BP (ICC = 0.655, P < 0.01), submaximal diastolic BP (ICC = 0.699; P < 0.01) and maximal systolic BP (ICC = 0.794; P ≤ 0.001) demonstrated substantial reliability. All other BP responses were not reliable. Despite the prognostic value of EBPR, only three BP responses used to categorize EBPR demonstrated substantial test–retest reliability in healthy young males. In clinical practice, these preliminary findings would support the use of exercise BPs to identify young males with elevated cardiovascular risk, but additional research is needed to improve the clinical utility of exercise BPs and EBPR in females.

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Fig. 1: Blood pressure (BP) responses during repeated exercise tests in males (blue triangles) and females (black circles).

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References

  1. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L. et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. J Am Med Assoc. 2017;317:165–82.

    Article  Google Scholar 

  2. Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertenion prevalence among adults aged 18 and over: United States, 2017-2018. NCHS Data Brief, no 364. Hyattsville, MD: National Center for Health Statistics; 2020.

  3. 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;62:317–29.

    Article  Google Scholar 

  4. Caselli S, Serdoz A, Mango F, Lemme E, Vaquer Segui A, Milan A, et al. High blood pressure response to exercise predicts future development of hypertension in young athletes. Eur Heart J. 2019;40:62–8.

    Article  Google Scholar 

  5. Currie KD, Floras JS, La Gerche A, Goodman JM. Exercise blood pressure guidelines: time to re-evaluate what is normal and exaggerated? Sports Med. 2018;48:1763–71.

    Article  Google Scholar 

  6. 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;128:873–934.

    Article  Google Scholar 

  7. ACSM’s Guidelines for Exercise Testing and Prescription. 10th ed. Philadelphia: Wolters Kluwer; 2018.

  8. Holmqvist L, Mortensen L, Kanckos C, Ljungman C, Mehlig K, Manhem K. Exercise blood pressure and the risk of future hypertension. J Hum Hypertens. 2012;26:691–5.

    Article  CAS  Google Scholar 

  9. Wilson NV, Meyer BM. Early prediction of hypertension using exercise blood pressure. Prev Med. 1981;10:62–8.

    Article  CAS  Google Scholar 

  10. Matthews CE, Pate RR, Jackson KL, Ward DS, Macera CA, Kohl HW, et al. Exaggerated blood pressure response to dynamic exercise and risk of future hypertension. J Clin Epidemiol. 1998;51:29–35.

    Article  CAS  Google Scholar 

  11. Schultz MG, Otahal P, Cleland VJ, Blizzard L, Marwick TH, Sharman JE. Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis. Am J Hypertens. 2013;26:357–66.

    Article  CAS  Google Scholar 

  12. Percuku L, Bajraktari G, Jashari H, Bytyci I, Ibrahimi P, Henein MY. Exaggerated systolic hypertensive response to exercise predicts cardiovascular events: a systematic review and meta-analysis. Pol Arch Intern Med. 2019;129:855–63.

    Google Scholar 

  13. Schultz MG, La Gerche A, Sharman JE. Blood pressure response to exercise and cardiovascular disease. Curr Hypertens Rep. 2017;19:89.

    Article  Google Scholar 

  14. 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. 2019;27:978–87.

    Article  Google Scholar 

  15. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71:1269–324.

    Article  CAS  Google Scholar 

  16. Warburton D, Jamnik V, Bredin S, Shephard R, Gledhill N. The 2019 physical activity readiness questionnaire for everyone (PAR-Q+) and electronic physical activity readiness medical examination (ePARmed-X+) health & fitness. J Can. 2018;11:80–3.

    Google Scholar 

  17. McInnis KJ, Balady GJ. Comparison of submaximal exercise responses using the Bruce vs modified Bruce protocols. Med Sci Sports Exerc. 1994;26:103–7.

    Article  CAS  Google Scholar 

  18. Sharman JE, LaGerche A. Exercise blood pressure: clinical relevance and correct measurement. J Hum Hypertens. 2015;29:351–8.

    Article  CAS  Google Scholar 

  19. Singh JP, Larson MG, Manolio TA, O’Donnell CJ, Lauer M, Evans JC, et al. Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study. Circulation 1999;99:1831–6.

    Article  CAS  Google Scholar 

  20. Bujang MA, Baharum N. A simplified guide to determination of sample size requirements for estimating the value of intraclass correlation coefficient: a review. Arch Orofac Sci. 2017;12:1–11.

    Google Scholar 

  21. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Toronto: Prentice-Hall Canada Inc.; 2000.

  22. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22:276–82.

    Article  Google Scholar 

  23. 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;71:445–52.

    Article  CAS  Google Scholar 

  24. Cameron JD, Stevenson I, Reed E, McGrath BP, Dart AM, Kingwell BA. Accuracy of automated auscultatory blood pressure measurement during supine exercise and treadmill stress electrocardiogram-testing. Blood Press Monit. 2004;9:269–75.

    Article  Google Scholar 

  25. Bauer P, Kraushaar L, Dorr O, Nef H, Hamm CW, Most A. Sex differences in workload-indexed blood pressure response and vascular function among professional athletes and their utility for clinical exercise testing. Eur J Appl Physiol. 2021;121:1859–69.

    Article  Google Scholar 

  26. Hedman K, Lindow T, Elmberg V, Brudin L, Ekstrom M. Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry. Eur J Prev Cardiol. 2020; 2047487320909667.

  27. Kim A, Deo SH, Fisher JP, Fadel PJ. Effect of sex and ovarian hormones on carotid baroreflex resetting and function during dynamic exercise in humans. J Appl Physiol (1985). 2012;112:1361–71.

    Article  CAS  Google Scholar 

  28. Lewandowski J, Pruszczyk P, Elaffi M, Chodakowska J, Wocial B, Switalska H, et al. Blood pressure, plasma NPY and catecholamines during physical exercise in relation to menstrual cycle, ovariectomy, and estrogen replacement. Regul Pept. 1998;75-76:239–45.

    Article  CAS  Google Scholar 

  29. Smith JR, Koepp KE, Berg JD, Akinsanya JG, Olson TP. Influence of sex, menstrual cycle, and menopause status on the exercise pressor reflex. Med Sci Sports Exerc. 2019;51:874–81.

    Article  Google Scholar 

  30. Mattu AT, Iannetta D, MacInnis MJ, Doyle-Baker PK, Murias JM. Menstrual and oral contraceptive cycle phases do not affect submaximal and maximal exercise responses. Scand J Med Sci Sports. 2020;30:472–84.

    Article  Google Scholar 

  31. Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, et al. Measurement of Blood Pressure in Humans: a Scientific Statement From the American Heart Association. Hypertension 2019;73:e35–e66.

    Article  CAS  Google Scholar 

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Funding

The project was supported by a seed grant from Michigan State University’s College of Education.

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KDC designed the study, conducted the experiments, analyzed and interpreted the data, and drafted, revised, and approved the paper. KMS conducted the experiments, analyzed the data, revised and approved the paper. JMS interpreted the data and drafted, revised, and approved the paper.

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Correspondence to Katharine D. Currie.

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Currie, K.D., Soave, K.M. & Slade, J.M. Reliability of blood pressure responses used to define an exaggerated blood pressure response to exercise in young healthy adults. J Hum Hypertens 37, 56–61 (2023). https://doi.org/10.1038/s41371-021-00623-3

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