Blood pressure response to maximal dynamic exercise testing in an athletic population

OBJECTIVE: Exaggerated blood pressure (BP) response to exercise testing has been linked to left ventricular hypertrophy and myocardial fibrosis in competitive athletes. Due to frequent training, athletes are particularly exposed to high BP levels, but data on the magnitude and distribution of BP response to exercise in athletic populations is scarce. METHODS: Cycle ergometry was performed in 2419 healthy competitive adolescent, professional and master athletes (age 26 ± 12 years, range 9-74, 27% women, 84 disciplines) for preparticipation screening. Fulfilling both subjective and at least two out of three objective exhaustion criteria (maximal heart rate >85% predicted, lactate ≥7 mmol/l, rate of perceived exertion ≥17) was required. Echocardiography was also performed. RESULTS: Maximal workload was 305 ± 59 W (mean ± SD) in men and 218 ± 40 in women. SBP increased significantly (men, Δ80 ± 20; women, Δ67 ± 16 mmHg; P < 0.001) to 204 ± 22 (men) and 180 ± 17 mmHg (women). DBP changed minimally (men: Δ0 ± 9, women: Δ2 ± 8 mmHg). The upper normative limit of SBP in men was 247 [95% CI 245-249; women: 214 (212-216) mmHg]. ESC guidelines of upper limits of maximal SBP were exceeded in 43% in men (>210 mmHg) and 28% in women (>190 mmHg). SBP response was more pronounced in endurance athletes, whereas DBP was slightly higher in strength athletes. Among cardiac dimensions, the strongest association for maximal SBP was found for left ventricular mass (r = 0.489; P < 0.001). CONCLUSION: SBP response to exercise testing is markedly exaggerated particularly in male endurance athletes. The prognostic significance of these findings regarding long-term cardiovascular alterations requires further clarification.