Incremental Value of Workload‐Indexed Blood Pressure Response Over Exaggerated Blood Pressure Response to Exercise in Detecting Adverse Left Ventricular Remodeling and Function

BACKGROUND: Exaggerated blood pressure response (ExBPR) to exercise, often defined as peak systolic blood pressure (SBP) ≥ 210 mm Hg in men and ≥190 mm Hg in women, has limited clinical utility due to inconsistent prognostic data. Workload-indexed SBP, expressed as SBP/metabolic equivalent of task (MET) slope, has emerged as a potentially superior marker of cardiovascular risk. This study aims to evaluate the association of exercise SBP parameters with left ventricular (LV) remodeling and function, and to unveil which exercise SBP marker more accurately reflects adverse cardiac remodeling and function. METHODS: We retrospectively studied 455 individuals who underwent echocardiography and treadmill testing within 1 day at a single center in Korea. Echocardiographic parameters included left ventricular (LV) end-diastolic dimension (EDD), relative wall thickness (RWT) and e' velocity. SBP/MET slope was calculated as (peak-resting SBP)/(maximal METs-1). RESULTS: Participants with SBP/Met slope >6.2 mm Hg/MET were older, had higher body mass index, and exhibited smaller LV EDD index, higher RWT, and lower e' velocity (all p < 0.05). They also showed higher resting and peak SBP and lower exercise capacity. ExBPR was associated with similar structural and functional abnormalities but not with exercise capacity. In individuals without ExBPR, higher SBP/MET slope identified smaller LV EDD index, higher RWT, and lower e' velocity (all p < 0.05). Multivariable analyses confirmed independent associations of SBP/MET slope with concentric LV structure represented by high RWT and lower e' velocity, beyond resting SBP. Adding SBP/MET slope to ExBPR improved prediction of reduced e' velocity (p = 0.021). CONCLUSIONS: SBP/MET slope was independently associated with concentric LV structure and diastolic dysfunction, providing incremental clinical value over ExBPR in detecting subclinical cardiac abnormalities.