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. 2025 Jun 3;14(11):e039457.
doi: 10.1161/JAHA.124.039457. Epub 2025 Jun 3.

Blood Pressure Responses During Exercise Were Associated With Average Home Blood Pressure and Home Blood Pressure Variability: The Electronic Framingham Heart Study

Xuzhi Wang  1 , Yuankai Zhang  1 , Chathurangi H Pathiravasan  2 , Nicole L Spartano  3 , Emelia J Benjamin  4   5   6 , David D McManus  7   8 , Gregory D Lewis  9   10 , Martin G Larson  1   4 , Ramachandran S Vasan  11   12 , Joanne M Murabito  4   13 , Chunyu Liu  1 , Matthew Nayor  4   5   11
Affiliations

Blood Pressure Responses During Exercise Were Associated With Average Home Blood Pressure and Home Blood Pressure Variability: The Electronic Framingham Heart Study

Xuzhi Wang et al. J Am Heart Assoc. .

Abstract

Background: Abnormal exercise blood pressure (BP) responses are associated with hypertension and cardiovascular disease, but their relationship with home BP over a mid- to long-term time span is unknown.

Methods: At an FHS (Framingham Heart Study) research examination (2016-2019), participants underwent maximum incremental ramp cycle ergometry cardiopulmonary exercise testing with BP measured every 2 minutes. At the same exam, English-speaking participants enrolled in the electronic FHS with an iPhone were provided with a digital BP cuff to measure home BP weekly for 1 year. Linear regression models examined associations of exercise BP with average home systolic BP (SBP), home-based hypertension, and week-to-week average real variability of home SBP, over 1-year follow-up. Participants with <3 weeks of BP return were excluded.

Results: Among 808 participants (mean age, 53 years; 58% women; 92% White individuals; 47% hypertension), higher exercise BP responses (peak SBP, SBP at 75 W, SBP/workload slope, peak diastolic BP, and diastolic BP at 75 W) were associated with higher average home SBP. Higher peak diastolic BP was associated with a greater risk for home hypertension. Additionally, higher SBP/workload slope and peak diastolic BP were associated with elevated average real variability of home SBP only in participants without antihypertensive use.

Conclusions: Higher exercise BP responses were associated with higher average home-based BP, greater home-based hypertension risk, and increased home-based BP variability over a mid- to long-term time span. However, these associations may vary by antihypertensive medication use. Exercise BP may play an important role in hypertension prevention and treatment.

Keywords: blood pressure; exercise; hypertension; mobile health.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Venn diagram for 3 types of hypertension.
The white space in the circle represents the participants without hypertension. The blue circle represents the participants who were categorized as having examination hypertension. The red circle represents the participants who were categorized as having home hypertension. The yellow circle represents the participants who were categorized as having exaggerated exercise BP. Each percentage shown within circles was the percentage of participants who were in that specific part. For example, 21.4% of the participants were categorized as having both home hypertension and examination hypertension but not exaggerated exercise BP. BP indicates blood pressure; DBP diastolic blood pressure; and SBP, systolic blood pressure.
Figure 2
Figure 2. Multivariable‐adjusted associations of exercise BP measures with average home SBP for participants not on antihypertensive medication (A) and all participants (B).
Point estimates and 95% CIs were plotted as points and bars for peak SBP, SBP at 75 W, SBP/workload slope, peak DBP, and DBP at 75 W. Point estimates and 95% CIs were also placed on the right of each panel. Red points and bars represented point estimates and 95% CIs for participants who had examination hypertension. Green points and bars represented point estimates and 95% CIs for participants who had no examination hypertension. Blue points and bars represented point estimates and 95% CIs for participants in both examination hypertension groups. The dotted line was placed at 0 β estimate. The model was adjusted for sex, age, examination SBP (or examination DBP), race, body mass index, smoking, total cholesterol, high‐density lipoprotein cholesterol, lipid treatment, blood glucose, prevalent diabetes, prevalent cardiovascular disease, and examination hypertension. All predictors and outcomes were scaled to 0 mean and unit variance. BP indicates blood pressure; DBP, diastolic blood pressure; and SBP indicates systolic blood pressure.
Figure 3
Figure 3. Multivariable‐adjusted associations of exercise BP measures with home hypertension for participants not on antihypertensive medication (A) and all participants (B).
Point estimates and 95% CIs were plotted as points and bars for peak SBP, SBP at 75 W, SBP/workload slope, peak DBP, and DBP at 75 W. Point estimates and 95% CIs were also placed on the right of each panel. Red points and bars represented point estimates and 95% CIs for participants who had examination hypertension. Green points and bars represented point estimates and 95% CIs for participants who had no examination hypertension. The blue points and bars represented point estimates and 95% CIs for participants in both examination hypertension groups. The dotted line was placed at null odds ratio equal to 1. The model was adjusted for sex, age, examination SBP (or examination DBP), race, body mass index, smoking, total cholesterol, high‐density lipoprotein cholesterol, lipid treatment, blood glucose, prevalent diabetes, prevalent cardiovascular disease, and examination hypertension. All predictors and outcomes were scaled to 0 mean and unit variance. BP indicates blood pressure; DBP, diastolic blood pressure; and SBP, systolic blood pressure.
Figure 4
Figure 4. Multivariable‐adjusted associations of exercise BP measures with ARV of home SBP for participants not on antihypertensive medication (A) and all participants (B).
Point estimates and 95% CIs were plotted as points and bars for peak SBP, SBP at 75 W, SBP/workload slope, peak DBP, and DBP at 75 W. Point estimates and 95% CIs were also placed on the right of each panel. The red points and bars represented point estimates and 95% CIs for participants who had examination hypertension. The green points and bars represented point estimates and 95% CIs for participants who had no examination hypertension. The blue points and bars represented point estimates and 95% CIs for participants in both examination hypertension groups. The dotted line was placed at 0 βestimate. The model was adjusted for sex, age, examination SBP (or examination DBP), race, body mass index, smoking, total cholesterol, high‐density lipoprotein cholesterol, lipid treatment, blood glucose, prevalent diabetes, prevalent cardiovascular disease, and examination hypertension. All predictors and outcomes were scaled to 0 mean and unit variance. ARV indicates average real variability; BP, blood pressure; DBP, diastolic blood pressure; and SBP, systolic blood pressure.
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