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Exercise Blood Pressure Guidelines: Time to Re-evaluate What is Normal and Exaggerated?

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Abstract

Blood pressure responses to graded exercise testing can provide important diagnostic and prognostic information. While published guidelines outline what constitutes a “normal” and “abnormal” (i.e., exaggerated) blood pressure response to exercise testing, the widespread use of exaggerated blood pressure responses as a clinical tool is limited due to sparse and inconsistent data. A review of the original sources from these guidelines reveals an overall lack of empirical evidence to support both the normal blood pressure responses and their upper limits. In this current opinion, we critically evaluate the current exercise blood pressure guidelines including (1) the normal blood pressure responses to graded exercise testing; (2) the upper limits of this normal response; (3) the blood pressure criteria for test termination; and (4) the thresholds for exaggerated blood pressure responses. We provide evidence that exercise blood pressure responses vary according to subject characteristics, and subsequently a re-evaluation of what constitutes normal and abnormal responses is necessary to strengthen the clinical utility of this assessment.

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Authors and Affiliations

  1. Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada

    Katharine D. Currie & Jack M. Goodman

  2. University Health Network and Mount Sinai Hospital Division of Cardiology, 600 University Avenue, Toronto, ON, M5G 1X5, Canada

    John S. Floras & Jack M. Goodman

  3. Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

    John S. Floras

  4. Sports Cardiology and Cardiac Magnetic Resonance Imaging Lab, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia

    Andre La Gerche

  5. Cardiology Department, St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia

    Andre La Gerche

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  1. Katharine D. Currie
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  2. John S. Floras
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  3. Andre La Gerche
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  4. Jack M. Goodman
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Correspondence to Jack M. Goodman.

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Funding

K. D. Currie is supported by a Fellowship from the Canadian Institutes of Health Research (MFE-140863). J. S. Floras holds the Tier 1 Canada Research Chair in Integrative Cardiovascular Biology.

Conflict of interest

K. D. Currie, J. S. Floras, A. La Gerche, and J. M. Goodman declare that they have no conflict of interest.

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Currie, K.D., Floras, J.S., La Gerche, A. et al. Exercise Blood Pressure Guidelines: Time to Re-evaluate What is Normal and Exaggerated?. Sports Med 48, 1763–1771 (2018). https://doi.org/10.1007/s40279-018-0900-x

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