The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance

Abstract

High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identification of high BP is conventionally based on in-clinic (resting) BP measures, performed within primary health care settings. However, many cases of high BP go unrecognised or remain inadequately controlled. Thus, there is a need for complementary settings and methods for BP assessment to identify and control high BP more effectively. Exaggerated exercise BP is associated with increased CVD risk and may be a medium to improve identification and control of high BP because it is suggestive of high BP gone undetected on the basis of standard in-clinic BP measures at rest. This paper provides the evidence to support a pathway to aid identification and control of high BP in clinical exercise settings via the measurement of exercise BP. It is recommended that exercise professionals conducting exercise testing should measure BP at a fixed submaximal exercise workload at moderate intensity (e.g., ~70% age-predicted heart rate maximum, stage 1–2 of a standard Bruce treadmill protocol). If exercise systolic BP is raised (≥170 mmHg), uncontrolled high BP should be assumed and should trigger correspondence with a primary care physician to encourage follow-up care to ascertain true BP control (i.e., home, or ambulatory BP) alongside a hypertension-guided exercise and lifestyle intervention to lower CVD risk related to high BP.

Assessment of Exercise Capacity in Home Healthcare

“…In addition to considering resting BP values, it is also important to consider exaggerated exercise BP responses, as this value has been linked with increased risk for cardiovascular disease. Schultz et al (2022) defined an SBP ≥170 mm Hg obtained with moderate-intensity exercise, defined by ~70% age-predicted HR maximum, to be considered an exaggerated exercise response. In light of the possibility of triggering an exaggerated BP response of greater than 170 mm Hg with activity, it was decided to exclude participants from the study if they presented with a resting SBP greater than 140 mm Hg, due to the higher possibility of triggering an exaggerated BP response with activity.…”

Acute and chronic cardiovascular responses to concentric and eccentric exercise in older adults with knee osteoarthritis

“…Blood pressures and heart rates were collected at rest, the final minute of each test stage, at minute six, and posttest minutes one and three. Exercise blood pressures have emerged as a method to identify individuals with high pressure that might have previously gone undetected in clinic [ 22 ]. Heart rates were obtained from the electrocardiogram system (Quinton Stress Testing System; Welch Allyn, Skaneateles Falls, NY).…”

“…It remains unclear which contraction type best improves cardiovascular adaptation and hemodynamic responses to walking activity. The intensities of walking exercise can vary from light to vigorous and are commensurate with stresses of daily life ambulatory activities, such as stair climbing, walking on a street uphill, or rushing to catch a train [ 22 ]. Improved blood pressure control during physical activity has prognostic implications for weathering ambulatory stressors in daily life, for reducing CVD morbidity and for lowering mortality risk [ 23 ].…”

Exercise-Induced Blood Pressure Dynamics: Insights from the General Population and the Athletic Cohort

“…More recently, however, the focus has shifted. Studies have now highlighted the importance of exaggerated exercise BP (EEBP) as a critical indicator of cardiovascular disease (CVD) risk [42][43][44]. In this context, submaximal BP measurements taken during moderate-intensity exercise have gained prominence.…”