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Exaggerated blood pressure response to submaximal exercise and cardiac target organ damage: importance of fitness

Journal of Human Hypertension volume 39, pages 849–858 (2025)Cite this article

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Abstract

Exaggerated systolic blood pressure (SBP) during submaximal exercise is associated with increased cardiovascular (CV) risk. However, findings are mixed and new evidence indicates that cardiorespiratory fitness should be considered for proper clinical interpretation of exercise SBP responses. This study aimed to determine the relationship between exercise SBP during submaximal effort corrected and uncorrected for fitness, as well as at peak effort and abnormalities of cardiac structure and function. Each of 231 participants with controlled BP (with or without previously diagnosed hypertension), no evidence for ischemic or valvular heart disease, or heart failure underwent cardiopulmonary exercise testing and resting and exercise echocardiography. Submaximal exercise SBP (measured at the 2nd stage of Bruce protocol) and peak exercise SBP was corrected for peak VO2. Associations with TOD – target organ damage (left ventricular [LV] mass, relative wall thickness, diastolic function, LV exercise reserve) were stronger for fitness-corrected than uncorrected exercise SBP. There was a progressive deterioration of cardiac function and structure parameters across the submaximal exercise SBP/peak VO2 tertiles. Multivariable models demonstrated that fitness-corrected SBP was more closely associated with LV hypertrophy and diastolic dysfunction than uncorrected SBP, and ROC analysis revealed better performance of fitness-corrected SBP than uncorrected SBP (AUC 0.792 vs. 0.627, and 0.808 vs. 0.662, both p < 0.001, for LV hypertrophy and diastolic dysfunction, respectively). Fitness-corrected SBP responses to submaximal exercise can identify more profound target organ damage with respect to cardiac function and structure even among patients with controlled clinic BP. Exaggerated BP response to exercise must be considered relative to fitness for proper clinical interpretation of BP responses to exercise testing.

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Data are available from the corresponding author on reasonable request.

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Funding

This work was funded by the grant from the National Science Centre Poland (UMO-201829/B/NZ5/01172.

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Authors and Affiliations

  1. Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland

    Jowita Zachwyc, Wojciech Kosowski, Anna K. Woznicka, Tomasz Kotwica, Monika Przewlocka-Kosmala & Wojciech Kosmala

  2. Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS 7000, Australia

    James E. Sharman & Wojciech Kosmala

  3. Department of Nursing, Wroclaw Medical University, Bartla 5, 51-618, Wroclaw, Poland

    Grzegorz Kubielas

Authors
  1. Jowita Zachwyc
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  2. James E. Sharman
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  3. Wojciech Kosowski
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  4. Anna K. Woznicka
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  5. Tomasz Kotwica
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  7. Monika Przewlocka-Kosmala
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  8. Wojciech Kosmala
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Contributions

WK, JS, MPK contributed to study conception and design, ethical approval, data collection, and analysis as well as manuscript writing. WK, JZ, AKW, WK, TK, and GK recruited participants, performed study procedures and provided feedback on manuscript writing. JZ, JS, AKW, TK, WK, MPK, GK and WK critically revised the manuscript.

Corresponding author

Correspondence to Wojciech Kosmala.

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Competing interests

The authors declare no competing interests.

Ethical approval

All methods were performed in accordance with the relevant guidelines and regulations. The study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Wroclaw Medical University. Informed consent was obtained from all participants.

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41371_2025_1079_MOESM1_ESM.pdf

Exaggerated blood pressure response to submaximal exercise and cardiac target organ damage: importance of fitness. Supplementary materials

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Zachwyc, J., Sharman, J.E., Kosowski, W. et al. Exaggerated blood pressure response to submaximal exercise and cardiac target organ damage: importance of fitness. J Hum Hypertens 39, 849–858 (2025). https://doi.org/10.1038/s41371-025-01079-5

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