Key result
Exaggerated exercise systolic blood pressure is linked to ~26% higher risk of incident hypertension.
Why the study?
Previous studies evaluated peak SBP or two-point slopes during exercise, but the value of full SBP time-series patterns for predicting future hypertension was unclear.
Does a high systolic blood pressure response during graded exercise predict future hypertension in normotensive adults?
Cohort (n=3,486)
Does a high systolic blood pressure response during graded exercise predict future hypertension in normotensive adults?
Effect estimate: HR 1.26 in men, 1.59 in women (relative to average risk) (95% CI 1.00-1.57 in men, 1.22-2.07 in women)
Absolute Event Rate: 27.8% vs 2.5%
Time-series analysis of exercise systolic blood pressure reveals distinct trajectory profiles that provide incremental predictive value for future hypertension diagnosis beyond resting and peak SBP, especially in women without prehypertension.
SBP trajectory patterns during exercise were associated with incident hypertension; leaves open whether they improve risk stratification beyond peak SBP in prospective cohorts.
Introduction: An exaggerated increase in systolic blood pressure (SBP) during exercise is associated with future hypertension. While previous studies evaluated peak SBP or two-point slopes, we aimed to identify SBP response patterns from the full SBP time-series during maximal incremental exercise and assess their value for predicting future hypertension diagnosis. Methods: In this cohort study, we analysed SBP recordings from 3,486 normotensive adults (mean age 50.6 years; 45% women) undergoing maximal cycle ergometry. Group-based trajectory modelling (GBTM) extracted sex-specific responses from the full SBP time-series. Associations with incident hypertension were evaluated using multivariable Cox analyses by sex and stratified by prehypertensive status (SBP 130-150 mmHg or DBP 85-90 mmHg). Results: In both sexes, GBTM identified three SBP response profiles, reflecting low, mid and high responders. Over 7.9 years, 171 men (8.8%) and 169 women (10.9%) were diagnosed with hypertension. Incidence was markedly higher in high versus low responders (e.g. in women: 27.8 vs 2.5 events per 1,000 follow-up years). The increased risk was independent of traditional risk factors, including resting SBP (hazard ratio relative to average risk (HRadj): 1.26 [95% confidence interval: 1.00-1.57] in men, 1.59 [1.22-2.07] in women). The association attenuated with increasing resting SBP in women (Pinteraction=0.003). Notably, high SBP response was independently associated with future hypertension diagnosis in those without prehypertension (e.g. in women, HRadj: 2.17 [1.49-3.17]), but not in those with prehypertension. Reclassification analyses indicated incremental predictive value beyond resting and peak SBP in women without prehypertension. Conclusions. Time-series analysis of exercise SBP revealed distinct response profiles predicting future hypertension diagnosis beyond resting blood pressure. Comprehensive interpretation of exercise SBP may improve risk stratification, particularly in women without prehypertension.
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Carlén et al. (2026) conducted a cohort in Normotension (evaluating risk for future hypertension) (n=3,486). High systolic blood pressure response profile during exercise vs. Low or average systolic blood pressure response was evaluated on Incident hypertension (HR 1.26 in men, 1.59 in women (relative to average risk), 95% CI 1.00-1.57 in men, 1.22-2.07 in women). High systolic blood pressure responses during maximal exercise predicted incident hypertension beyond traditional risk factors (HR relative to average risk: 1.26 in men, 1.59 in women).
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