Wakeham Denis J, De Oliveria Gomes Diana, Howrey Matthew M, Bagga Joetsaroop S, Hughes Seamus B, Brazile Tiffany L, Hieda Michinari, Howden Erin J, MacNamara James P, Levine Benjamin D, Hearon Christopher M, Sarma Satyam
Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital.
The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
J Hypertens. 2025 Jul 3. doi: 10.1097/HJH.0000000000004074.
Exaggerated exercise blood pressure (EEBP) is typically defined using systolic blood pressure (SBP) thresholds at maximal exercise of ≥190 (women) and ≥210 mmHg (men). However, SBP/workload and SBP/oxygen uptake (V̇O2) slopes have been shown to be more sensitive predictors of all-cause mortality and/or cardiovascular morbidity than peak exercise SBP. Hypertensive adults with left ventricular hypertrophy (LVH) often present with EEBP; whether the change in SBP with exercise is also greater when normalized for workload/V̇O2 is unknown. Therefore, we compared absolute and normalized exercise SBP in adults with LVH and age-matched healthy controls.
We measured BP (brachial electrosphygmomanometry) and V̇O2 (indirect calorimetry) during treadmill exercise in middle-aged adults who were either healthy (n = 52) or had LVH and elevated cardiac biomarkers (n = 48). Data were compared using Welch's t-tests and Fisher's exact tests.
Absolute V̇O2 max was not different between groups (LVH: 2.24 ± 0.61 vs. Healthy: 2.21 ± 0.69 l/min, P = 0.862). Baseline (P < 0.001) and max SBP were higher in LVH (196 ± 25 vs. 173 ± 26 mmHg, P < 0.001); as such EEBP incidence was higher in LVH (48 vs. 11%, P < 0.001) when measured using the SBP thresholds. However, there was no difference in the change in SBP from rest (P = 0.174) nor the SBP/V̇O2 slope between groups (LVH: 37 ± 18 vs. Healthy: 33 ± 17 mmHg/l/min, P = 0.334).
The greater EEBP incidence in LVH using traditional thresholds reflects differences in resting BP, not an exaggerated SBP response. Therefore, those with high-risk LVH have a normal SBP response to exercise despite achieving a higher max SBP for the same absolute V̇O2 max.
运动性高血压（EEBP）通常根据最大运动时收缩压（SBP）阈值来定义，女性≥190mmHg，男性≥210mmHg。然而，SBP/工作量和SBP/摄氧量（V̇O2）斜率已被证明比运动峰值SBP更能敏感地预测全因死亡率和/或心血管疾病发病率。患有左心室肥厚（LVH）的高血压成年人常出现EEBP；当根据工作量/V̇O2进行标准化时，运动时SBP的变化是否也更大尚不清楚。因此，我们比较了患有LVH的成年人与年龄匹配的健康对照者的绝对运动SBP和标准化运动SBP。
我们在跑步机运动期间测量了中年成年人的血压（肱动脉电子血压计）和V̇O2（间接量热法），这些成年人要么健康（n = 52），要么患有LVH且心脏生物标志物升高（n = 48）。使用韦尔奇t检验和费舍尔精确检验对数据进行比较。
两组之间的绝对最大摄氧量（V̇O2 max）没有差异（LVH组：2.24±0.61 vs.健康组：2.21±0.69 l/min，P = 0.862）。LVH组的基线（P < 0.001）和最大SBP更高（196±25 vs. 173±26 mmHg，P < 0.001）；因此，使用SBP阈值测量时，LVH组的EEBP发病率更高（48% vs. 11%，P < 0.001）。然而，两组之间静息时SBP的变化（P = 0.174）以及SBP/V̇O2斜率均无差异（LVH组：37±18 vs.健康组：33±17 mmHg/l/min，P = 0.334）。
使用传统阈值时，LVH组中较高的EEBP发病率反映的是静息血压的差异，而非SBP反应过度。因此，尽管在相同的绝对最大摄氧量（V̇O2 max）下达到了更高的最大SBP，但高危LVH患者对运动的SBP反应正常。
