Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts.
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts.
Clin Ther. 2022 Jan;44(1):11-22.e3. doi: 10.1016/j.clinthera.2021.10.013. Epub 2021 Nov 21.
Although exercise testing guidelines define cutoffs for an exaggerated exercise systolic blood pressure (SBP) response, SBPs above these cutoffs are not uncommon in athletes given their high exercise capacity. Alternately, guidelines also specify a normal SBP response that accounts for metabolic equivalents (METs; mean [SD] of 10 [2] mm Hg per MET or 3.5 mL/kg/min oxygen consumption [V˙o]). SBP and V˙o increase less during exercise in females than males. It is not clear if sex-based differences in exercise SBP are related to differences in V˙o or if current recommendations for normal increase in SBP per MET produce reasonable estimates using measured METs (ie, V˙o) in athletes. We therefore examined sex-based differences in exercise SBP indexed to V˙o in athletes with the goal of defining normative values for exercise SBP that account for fitness and sex.
Using prospectively collected data from a single sports cardiology program, normotensive athlete patients were identified who had no relevant cardiopulmonary disease and had undergone cardiopulmonary exercise testing with cycle ergometry or treadmill. The relationship between ΔSBP (peak - rest) and ΔV˙o (peak - rest) was examined in the total cohort and compared between sexes.
A total of 413 athletes (mean [SD] age, 35.5 [14] years; 38% female; mean [SD] peak V˙o, 46.0 [10.2] mL/kg/min, 127% [27%] predicted) met the inclusion criteria. The ΔSBP correlated with unadjusted ΔV˙o (cycle: R = 0.18, treadmill: R = 0.12; P < 0.0001). Female athletes had lower mean (SD) peak SBP (cycle: 161 [15] vs 186 [24] mm Hg; treadmill: 165 [17] vs 180 [20] mm Hg; P < 0.05) than male athletes. Despite lower peak SBP, mean (SD) ΔSBP relative to unadjusted ΔV˙o was higher in female than male athletes (cycle: 25.6 [7.2] vs 21.1 [7.3] mm Hg/L/min; treadmill: 21.6 [7.2] vs 17.0 [6.2] mm Hg/L/min; P < 0.05). When V˙o was adjusted for body size and converted to METs, female and male athletes had similar mean (SD) ΔSBP /ΔMET (cycle: 6.0 [2.1] vs 5.8 [2.0] mm Hg/mL/kg/min; treadmill: 4.7 [1.8] vs 4.8 [1.7] mm Hg/mL/kg/min).
In this cohort of athletes without known cardiopulmonary disease, observed sex-based differences in peak exercise SBP were in part related to the differences in ΔV˙o between male and female athletes. Despite lower peak SBP, ΔSBP/unadjusted ΔV˙o was paradoxically higher in female athletes. Future work should define whether this finding reflects sex-based differences in the peripheral vascular response to exercise. In this athletic cohort, ΔSBP/ΔMET was similar between sexes and much lower than the ratio that has been proposed by guidelines to define a normal SBP response. Our observed ΔSBP/ΔMET, based on measured rather than estimated METs, provides a clinically useful estimate for normal peak SBP range in athletes.
尽管运动测试指南定义了收缩压（SBP）反应过度的截断值，但考虑到运动员的高运动能力，这些截断值以上的 SBP 并不少见。另外，指南还规定了正常的 SBP 反应，该反应考虑了代谢当量（MET；每 MET 的平均[SD]为 10[2]mmHg 或 3.5mL/kg/min 耗氧量[V˙o]）。女性在运动过程中 SBP 和 V˙o 的增加低于男性。目前尚不清楚女性运动 SBP 的性别差异是否与 V˙o 的差异有关，或者目前使用测量的 MET（即 V˙o）来估算正常增加的 SBP 每 MET 是否会产生合理的估计值。因此，我们研究了运动员运动 SBP 与 V˙o 的性别差异，目的是确定考虑到健康和性别的运动 SBP 的正常值。
使用来自单一运动心脏病学计划的前瞻性收集数据，确定无相关心肺疾病且已接受功率自行车或跑步机心肺运动测试的正常血压运动员患者。在总队列中检查了 ΔSBP（峰值-休息）与 ΔV˙o（峰值-休息）之间的关系，并比较了性别之间的关系。
共有 413 名运动员（平均[SD]年龄 35.5[14]岁；38%为女性；平均[SD]峰值 V˙o 46.0[10.2]mL/kg/min，预测值的 127%[27%]）符合纳入标准。ΔSBP 与未调整的 ΔV˙o 相关（功率自行车：R=0.18，跑步机：R=0.12；P<0.0001）。女性运动员的平均（SD）峰值 SBP（功率自行车：161[15] vs 186[24]mmHg；跑步机：165[17] vs 180[20]mmHg；P<0.05）低于男性运动员。尽管峰值 SBP 较低，但与未调整的 ΔV˙o 相比，女性运动员的平均（SD）ΔSBP 相对较高（功率自行车：25.6[7.2] vs 21.1[7.3]mmHg/L/min；跑步机：21.6[7.2] vs 17.0[6.2]mmHg/L/min；P<0.05）。当 V˙o 根据身体大小进行调整并转换为 MET 时，女性和男性运动员的平均（SD）ΔSBP/ΔMET（功率自行车：6.0[2.1] vs 5.8[2.0]mmHg/mL/kg/min；跑步机：4.7[1.8] vs 4.8[1.7]mmHg/mL/kg/min）相似。
在本队列中，患有已知心肺疾病的运动员中，观察到的男性和女性运动员之间的峰值运动 SBP 性别差异部分与运动员之间的 ΔV˙o 差异有关。尽管峰值 SBP 较低，但与未调整的 ΔV˙o 相比，女性运动员的 ΔSBP 更高。未来的工作应该确定这一发现是否反映了运动对女性外周血管反应的性别差异。在这个运动队列中，ΔSBP/ΔMET 在性别之间相似，远低于指南建议的定义正常 SBP 反应的比值。我们观察到的基于实测而不是估算的 MET 的 ΔSBP/ΔMET 提供了一个在运动员中正常峰值 SBP 范围的临床有用估计值。
