Association of ambulatory waveform-derived pulse wave velocity with blood pressure response to exercise: role of fitness correction

OBJECTIVES: Exercise blood pressure response (EBPR) is influenced by arterial stiffness, reflected by pulse wave velocity (PWV). Adjustment for cardiorespiratory fitness may refine its interpretation. Brachial waveform-derived PWV remains underused due to concerns about age and SBP dependence, and single-point office PWV may inadequately represent the dynamic vascular load driving EBPR. We hypothesized that 24-h PWV would outperform office PWV in predicting EBPR, and that indexing exercise SBP to aerobic fitness would strengthen these associations. METHODS: We studied 228 adults (46% men; age 53 ± 12 years) with adequately controlled blood pressure, irrespective of hypertension diagnosis. Individuals with coronary artery disease, valvular disease, or heart failure were excluded. All participants underwent office and 24-h blood pressure monitoring with integrated pulse wave analysis (Mobil-O-Graph), cardiopulmonary exercise testing, and echocardiography. Exercise SBP at submaximal and peak workloads was normalized to peak oxygen uptake (VO2). RESULTS: Fitness-corrected SBP showed stronger associations with PWV than uncorrected values (r = 0.64 vs. 0.15; P < 0.001). Both submaximal and peak SBP indexed to peak VO2 increased stepwise across 24-h PWV tertiles; this gradient was attenuated without fitness correction. After adjustment for age, sex, SBP, BMI, and left ventricular hypertrophy and diastolic dysfunction, 24-h PWV remained an independent predictor of fitness-corrected EBPR, whereas office PWV was not statistically significant. CONCLUSION: Brachial BP-waveform-derived PWV independently predicts EBPR. Ambulatory 24-h PWV demonstrates stronger associations with exercise BP behaviour compared with single-time-point office PWV, and fitness-corrected SBP outperforms conventional uncorrected measures.