Influence of Fitness on Exercise Blood Pressure and Cardiac Structure: Data from the Exercise Stress Test Collaboration (EXERTION).

PurposeAn abnormally high exercise systolic blood pressure (SBP) is associated with adverse left ventricular (LV) remodelling, a hallmark of hypertensive-heart disease. Fitness may modify this relationship through its effects on BP and cardiac structure, influencing the interpretation of exercise test results. This study explored the influence of fitness on the exercise SBP-cardiac structure relationship in individuals undergoing exercise stress echocardiography.MethodsCardiovascular structure and function (LV mass indexed to body surface area (LVMIBSA), relative wall thickness (RWT), cardiac output (CO) and total peripheral resistance (TPR)) were assessed by echocardiography in 5,087 individuals (aged 59.7±12.7 years, 53.1% male). BP was measured at peak exercise workload. Fitness was estimated by maximal oxygen consumption (VO2max) and categorised into three groups (low, moderate and high) based on age- and sex-predicted VO2max values. Regression analysis examined interactions of fitness on the exercise SBP-LV structure relationship, adjusting for age, sex, pre-exercise SBP, and history of cardiovascular disease.ResultsPeak SBP was positively associated with LVM, LVMIBSA and RWT (all p