Heart, Lung and Circulation

Modest Association Between Peak Exercise Blood Pressure and Ambulatory Hypertension in Endurance Athletes


      An exaggerated blood pressure (BP) response to exercise is common in endurance athletes. The association between exercise systolic blood pressure (SBP) and hypertension is not well established in this group.


      250 endurance athletes (75% male) performed a maximal cycle exercise test with BP measured every 2 min. Athletes were diagnosed with exercise induced hypertension (EIH) based on international guidelines (SBP ≥210mmHg males, ≥190mmHg females). Office hypertension (OH) was identified from either supine SBP ≥140mmHg or diastolic BP ≥90mmHg, or if treated for hypertension. 24h ambulatory blood pressure monitoring (ABPM) was performed in a subset of 42 athletes with EIH and 9 athletes with a normotensive response to exercise (NRE).


      Peak exercise SBP values were high (221±26mmHg in males and 199±21mmHg in females). 71% of athletes met criteria for EIH. In the full cohort, resting SBP was higher in the EIH group (EIH: 128±13mmHg vs NRE: 122±15mmHg, P=0.006), however prevalence of OH between the EIH (19%) and NRE (15%) groups were similar (P=0.59). In the subset of athletes who underwent 24h ABPM (n=51), there were no diagnoses of clinical hypertension in NRE (n=9). Of the 42 athletes with EIH, a majority (n=32, 76%) were normotensive on ABPM. 10 athletes with EIH were classified with hypertension on ABPM. Only two of these athletes would have been identified with office BP measures.


      EIH is common in endurance athletes that may reflect superior cardiac output during exercise. EIH is associated with mild hypertension in only a small proportion of athletes.