Estimation of the blood pressure response with exercise stress testing

Background: The blood pressure response to exercise has been described as a significant increase in systolic BP (sBP) with a smaller change in diastolic BP (dBP). This has been documented in small numbers, in healthy young men or in ethnic populations. This study examines these changes in low to intermediate risk of myocardial ischaemia in men and women over a wide age range. Methods: Consecutive patients having stress echocardiography were analysed. Ischaemic tests were excluded. Manual BP was estimated before and during standard Bruce protocol treadmill testing. Patient age, sex, body mass index (BMI), and resting and peak exercise BP were recorded. Results: 3200 patients (mean age 58 ± 12 years) were included with 1123 (35%) females, and 2077 males, age range 18 to 93 years. Systolic BP increased from 125 ± 17 mmHg to 176 ± 23 mmHg. The change in sBP (ΔsBP) was 51 mmHg (95% CI 51,52). The ΔdBP was 1 mmHg (95% CI 1, 1), from 77 to 78 mmHg, p < 0.001). The upper limit of normal peak exercise sBP (determined by the 90th percentile) was 210 mmHg in males and 200 mmHg in females. The upper limit of normal ΔsBP was 80 mmHg in males and 70 mmHg in females. The lower limit of normal ΔsBP was 30 mmHg in males and 20 mmHg in females. Conclusions: In this large cohort, sBP increased significantly with exercise. Males had on average higher values than females. Similar changes were seen with the ΔsBP. The upper limit of normal for peak exercise sBP and ΔsBP are reported by age and gender