Zachwyc J; Wroclaw Medical University, Wroclaw, Poland.
Sharman JE; Kosowski W; Przewlocka-Kosmala M; et al

Journal of Hypertension. 44(11):2018-2026, 2026 Nov 01.

OBJECTIVES: Exercise blood pressure response (EBPR) is influenced by
arterial stiffness, reflected by pulse wave velocity (PWV). Adjustment for
cardiorespiratory fitness may refine its interpretation. Brachial
waveform-derived PWV remains underused due to concerns about age and SBP
dependence, and single-point office PWV may inadequately represent the
dynamic vascular load driving EBPR. We hypothesized that 24-h PWV would
outperform office PWV in predicting EBPR, and that indexing exercise SBP
to aerobic fitness would strengthen these associations.

METHODS: We studied 228 adults (46% men; age 53 +/- 12 years) with
adequately controlled blood pressure, irrespective of hypertension
diagnosis. Individuals with coronary artery disease, valvular disease, or
heart failure were excluded. All participants underwent office and 24-h
blood pressure monitoring with integrated pulse wave analysis
(Mobil-O-Graph), cardiopulmonary exercise testing, and echocardiography.
Exercise SBP at submaximal and peak workloads was normalized to peak
oxygen uptake (VO2).

RESULTS: Fitness-corrected SBP showed stronger associations with PWV than
uncorrected values (r = 0.64 vs. 0.15; P < 0.001). Both submaximal and
peak SBP indexed to peak VO2 increased stepwise across 24-h PWV tertiles;
this gradient was attenuated without fitness correction. After adjustment
for age, sex, SBP, BMI, and left ventricular hypertrophy and diastolic
dysfunction, 24-h PWV remained an independent predictor of
fitness-corrected EBPR, whereas office PWV was not statistically
significant.

CONCLUSION: Brachial BP-waveform-derived PWV independently predicts EBPR.
Ambulatory 24-h PWV demonstrates stronger associations with exercise BP
behaviour compared with single-time-point office PWV, and
fitness-corrected SBP outperforms conventional uncorrected measures.