Sex differences in workload-indexed blood pressure response and vascular function among professional athletes and their utility for clinical exercise testing

Abstract

Purpose Sex differences in blood pressure (BP) regulation at rest have been attributed to differences in vascular function. Further, arterial stiffness predicts an exaggerated blood pressure response to exercise (BPR) in healthy young adults. However, the relationship of vascular function to the workload-indexed BPR and potential sex differences in athletes are unknown. Methods We examined 47 male (21.6 ± 1.7 years) and 25 female (21.1 ± 2 years) athletes in this single-center pilot study. We assessed vascular function at rest, including systolic blood pressure (SBP). Further, we determined the SBP/W slope, the SBP/MET slope, and the SBP/W ratio at peak exercise during cycling ergometry. Results Male athletes had a lower central diastolic blood pressure (57 ± 9.5 vs. 67 ± 9.5 mmHg, p < 0.001) but a higher central pulse pressure (37 ± 6.5 vs. 29 ± 4.7 mmHg, p < 0.001), maximum SBP (202 ± 20 vs. 177 ± 15 mmHg, p < 0.001), and ΔSBP (78 ± 19 vs. 58 ± 14 mmHg, p < 0.001) than females. Total vascular resistance (1293 ± 318 vs. 1218 ± 341 dyn*s/cm5, p = 0.369), pulse wave velocity (6.2 ± 0.85 vs. 5.9 ± 0.58 m/s, p = 0.079), BP at rest (125 ± 10/76 ± 7 vs. 120 ± 11/73.5 ± 8 mmHg, p > 0.05), and the SBP/MET slope (5.7 ± 1.8 vs. 5.1 ± 1.6 mmHg/MET, p = 0.158) were not different. The SBP/W slope (0.34 ± 0.12 vs. 0.53 ± 0.19 mmHg/W) and the peak SBP/W ratio (0.61 ± 0.12 vs. 0.95 ± 0.17 mmHg/W) were markedly lower in males than in females (p < 0.001). Conclusion Male athletes displayed a lower SBP/W slope and peak SBP/W ratio than females, whereas the SBP/MET slope was not different between the sexes. Vascular functional parameters were not able to predict the workload-indexed BPR in males and females.

Systolic Blood Pressure Response to Exercise in Endurance Athletes in Relation to Oxygen Uptake, Work Rate and Normative Values

“…Second, all the included subjects were well-trained endurance athletes of middle age. Although this complements previously published data in younger athletes of other sport disciplines [ 10 , 21 ], our results should not be extrapolated to athletes of all ages and all sports. Third, our CPET protocol included an instant increase in work rate at the start of the ramp protocol in order to reduce the total work time for athletes while allowing a standardized measure at 50 W for all subjects.…”

“…Second, using the same rationale, the SBP/VO 2 slope was calculated by dividing the increment in SBP by the difference in VO 2 , i.e., with data from the timepoints for the first and the last SBP measurement during exercise. Third, the SBP/MET slope was calculated using two different methods: (a) by using the same datapoints as for the SBP/VO 2 slope (above) and (b) by replacing the first SBP measure during exercise with SBP at rest, in the sitting position, and using one MET as oxygen uptake at rest to allow for comparison with previous studies [ 10 , 11 , 21 ]. Predicted values for the SBP max and the SBP/W slope were calculated using the formulas provided by Hedman et al [ 9 ].…”

“…Furthermore, for the increase in SBP in relation to the increase in metabolic equivalents of task (MET), the SBP/MET slope, upper limits have been suggested [ 7 ]. In addition, a few recent studies have investigated the SBP/W and the SBP/MET slopes in young athletes engaged in team sports [ 10 , 11 ]. There is, however, a lack of studies specifically dedicated to endurance athletes, who through their enhanced aerobic capacity can reach the highest VO 2 values and, thus, may be expected to reach even higher SBP max values.…”

Low but not high exercise systolic blood pressure is associated with long-term all-cause mortality

“…This measure index ΔSBP to the increase in METs from rest to peak exercise, and the relation between SBP and the SBP/MET-slope has recently been described in healthy athletes. 25 This measure accounts for the confounding effect of workload, associated with both the risk of mortality and exercise SBP. In contrast to our previous finding of higher risk of all-cause mortality in subjects with higher SBP/MET-slope, 10 subjects in the lower 10h percentile (with the highest risk of all-cause mortality in the current study) presented with the lowest mean SBP/MET-slope.…”

Modeling and Analysis of Influencing Factors of Competitive Performance of Wushu Athletes

“…The next decomposition can be carried out only after the quantity and name of the primary index are determined according to the requirements and purpose of evaluation. The determination of primary indicators should be based on the main aspects of the requirements of wushu sports on athletes' competitive ability, as well as the principle of constructing the evaluation index system [20], as well as the organization of the evaluation. In the determination of primary indicators, this paper mainly determines two key primary indicators: competitive ability and play ability, see Table 1 for details.…”