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Int J Appl Basic Med Res
Int J Appl Basic Med Res
IJABMR
Int J App Basic Med Res
International Journal of Applied and Basic Medical Research
2229-516X
2248-9606
Wolters Kluwer - Medknow India

IJABMR-14-208
10.4103/ijabmr.ijabmr_106_24
Letter to the Editor
Resting Blood Pressure is an Essential Determinant of Blood Pressure Response to Exercise
Çoner Ali
Öncel Can Ramazan
Köseoglu Cemal
Dagasan Göksel
Department of Cardiology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya/Antalya, Turkiye
Address for correspondence: Dr. Ali Çoner, Alanya Alaaddin Keykubat University, Kestel, Merines Caddesi, Alanya/Antalya 07450, Turkiye. E-mail: conerali@hotmail.com
Jul-Sep 2024
24 8 2024
14 3 208209
09 3 2024
13 5 2024
13 7 2024
Copyright: © 2024 International Journal of Applied and Basic Medical Research
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcTo the Editor,

I read with great interest the article titled “Assessment of Cardiovascular Parameters on Submaximal Treadmill Exercise in Obese versus Nonobese Adults” by Gupta et al. In this article, the authors reported that systolic and diastolic blood pressure (BP) measurements along with heart rate recovery parameters increased in obese adults more than in nonobese adults with submaximal treadmill exercise test.[1] They suggested that this increase in cardiovascular parameters was primarily associated with autonomic dysfunction and increased sympathetic hyperactivity. We would like to highlight the factors that should be considered when comparing BP responses to exercise test between patient groups with different phenotypes. As emphasized by Gupta et al., the most important mechanism in the development of exaggerated BP response to exercise is the lack of a sufficient decrease in peripheral vascular resistance despite the increased cardiac output with exercise.[2] Although the most likely cause of this insufficient decrease in peripheral vascular resistance is thought to be autonomic dysfunction and increased sympathetic hyperactivity, metabolic and inflammatory factors should also be investigated.[34] Abnormalities in fasting blood glucose, high sensitive C-reactive protein or thyroid hormone levels may affect the BP response to exercise test through impairing endothelial functions and blunting the expected decrement in peripheral vascular resistance.

In current ACC/AHA guidelines for hypertension suggested “normal” BP as systolic BP <120 mmHg and diastolic BP as <80 mmHg.[5] In the study conducted by Gupta et al., the mean preexercise BP values of the participants in the obese group were given as 122.5 and 82.9 mmHg. In other words, the preexercise BP values of those in the obese group were already above normal. Additionally, the preexercise blood pressure in obese group was also higher than in non-obese group (122.5/82.9 mmHg vs. 113.9/76.1 mmHg, P values both for systolic and diastolic BP were 0.001). Resting BP is an essential determinant of increased BP response to exercise. There was a statistical significance regarding the preexercise blood pressure between obese and non-obese groups. Patients with BP above “normal” at rest are also at risk for the presence of masked hypertension.[67] Therefore, resting BP and the possible masked hypertension should be searched strictly in patients with an increased BP response to exercise. In studies investigating BP response to exercise, it may be useful to enrol the study patients under the guidance of 24-h ambulatory BP monitoring to eliminate the baseline variability between groups.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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1 Gupta A Garg R Chawla SP Kaur S Goyal S Assessment of cardiovascular parameters on submaximal treadmill exercise in obese versus nonobese adults Int J Appl Basic Med Res 2023 13 212 7 38229726
2 Tokushige A Ohishi M Pathophysiology of the exaggerated blood pressure response to exercise Hypertens Res 2022 45 2028 9 36207532
3 Sunita Mahajan AS Jain A Singh N Mishra T Heart rate and blood pressure response to exercise and recovery in subclinical hypothyroid patients Int J Appl Basic Med Res 2013 3 106 10 24083145
4 Çoner A Gençtoy G Akinci S Altin C Müderrisoğlu H Assessment of vascular inflammation and subclinical nephropathy in exaggerated blood pressure response to exercise test Blood Press Monit 2019 24 114 9 30969228
5 Whelton PK Carey RM Aronow WS Casey DE Jr Collins KJ Dennison Himmelfarb C 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline fort he prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines Circulation 2018 138 e426 83 30354655
6 Cuspidi C Gherbesi E Faggiano A Sala C Carugo S Grassi G Masked hypertension and exaggerated blood pressure response to exercise: A review and meta-analysis Diagnostics (Basel) 2023 13 1005 36980313
7 Cuspidi C Gherbesi E Faggiano A Sala C Grassi G Carugo S Targeting hypertensive response to exercise and the association of masked hypertension with subclinical organ damage: A mini-review and meta-analysis Am J Hypertens 2024 37 53 9 37195645
