Beyond resting measurements: exercise pulse pressure and its association with heart failure hospitalization

Background: Pulse pressure (PP), the difference between SBP and DBP, is a known predictor of heart failure. While high resting PP has been linked to increased heart failure risk, the implications of exercise-induced PP changes remain less understood. This study investigates the contrasting roles of exercise PP in predicting hospitalization for heart failure (hHF). Methods: We conducted a retrospective analysis of adults referred for treadmill exercise testing between 2003 and 2012. ΔMaximal blood pressure (BP) referred to the BP change from rest to peak exercise. Cox proportional hazards models adjusted for demographic and clinical variables were used to assess the predictive value of PP changes for hHF. Results: Among 15 249 participants, 117 (0.7%) were hospitalized for HF over a median follow-up of 112 months. Higher resting PP was significantly associated with an increased risk of hHF, whereas increased exercise PP was inversely related to hHF risk independently (adjusted hazard ratio: 0.988, 95% confidence interval: 0.977–0.998, P < 0.001). Conclusion: Resting PP and Exercise PP exhibit opposite effects on the risk of heart failure hospitalization. These findings suggest the importance of considering both resting and exercise-induced PP changes in the assessment and management of heart failure risk.