Exercise-Induced Blood Pressure Dynamics: Insights from the General Population and the Athletic Cohort

Abstract

Blood pressure (BP) dynamics during graded exercise testing provide important insights into cardiovascular health, particularly in athletes. These measurements, taken during intense physical exertion, complement and often enhance our understanding beyond traditional resting BP measurements. Historically, the challenge has been to distinguish 'normal' from 'exaggerated' BP responses in the athletic environment. While basic guidelines have served their purpose, they may not fully account for the complex nature of BP responses in today's athletes, as illuminated by contemporary research. This review critically evaluates existing guidelines in the context of athletic performance and cardiovascular health. Through a rigorous analysis of the current literature, we highlight the multifaceted nature of exercise-induced BP fluctuations in athletes, emphasising the myriad determinants that influence these responses, from specific training regimens to inherent physiological nuances. Our aim is to advocate a tailored, athlete-centred approach to BP assessment during exercise. Such a paradigm shift is intended to set the stage for evidence-based guidelines to improve athletic training, performance and overall cardiovascular well-being.

Keywords: blood pressure; cardiovascular risk; exercise; guidelines; prognosis.

Figure 1

Comparative Systolic Blood Pressure Thresholds During Exercise as Recommended by Leading Health Associations. This figure graphically illustrates the recommended systolic blood pressure (SBP) thresholds during exercise by the American Heart Association (AHA), the European Society of Cardiology (ESC), and the American College of Sports Medicine (ACSM). The lengths of the bars correspond to the numerical values of the thresholds, with AHA recommending an SBP of ≥210 mmHg for men and ≥190 mmHg for women, which includes a normative increase of 10 mmHg per MET. ESC proposes slightly higher thresholds of ≥220 mmHg for men and ≥200 mmHg for women. ACSM advises a universal threshold of ≥225 mmHg, applicable to all genders. These visual bars serve to provide a clear, at-a-glance comparison of the SBP thresholds across different guidelines.

Figure 2

Determinants of BP variability during exercise. This schematic illustrates the factors that influence the response of blood pressure (BP) to exercise. Age affects vascular compliance by increasing arterial stiffness and affecting BP. Hormones such as testosterone and estrogen influence vascular resistance and vasodilation, respectively, and alter BP. Cardiovascular fitness correlates with higher peak systolic BP. Medication, especially antihypertensives, can modulate peak BP, while NSAIDs can increase BP by vasoconstriction. Genetic factors play a role in individual BP responses to exercise. Different types of exercise have different effects: aerobic exercise tends to reduce vascular resistance and lower BP, while resistance and isometric exercises can increase BP by increasing muscle tension. The cyclist image was generated using DALL·E 3.