Hypertensive Response to Exercise

Definition and Criteria

The American Heart Association defines a hypertensive response to exercise as a peak systolic blood pressure ≥210 mm Hg in men and ≥190 mm Hg in women, or a peak diastolic blood pressure ≥90 mm Hg, according to the 2013 guidelines 1, 2, 3
The American Heart Association recommends that peak systolic BP ≥210 mm Hg for men and peak systolic BP ≥190 mm Hg for women be used as criteria for a hypertensive response to exercise 1, 2, 3
Systolic BP >250 mm Hg represents a relative indication for test termination, as recommended by the American Heart Association 1, 2, 3

A rise in diastolic BP >10 mm Hg above resting value during exercise or an absolute diastolic BP value of ≥90 mm Hg during exercise is considered a hypertensive response, according to the American Heart Association guidelines 1, 2, 3
Diastolic BP >115 mm Hg represents a relative indication for test termination, as recommended by the American Heart Association 1, 2, 3

An exaggerated systolic BP response indicates increased risk for future hypertension, left ventricular hypertrophy, and cardiovascular events, but does not necessarily indicate current coronary artery disease, according to the American Heart Association guidelines 1, 2, 3
Failure of systolic BP to fall during recovery or a rise relative to maximal exercise value predicts increased risk of death, as reported in the Journal of the American College of Cardiology 1, 2, 3
Elevated systolic or diastolic BP at 3 minutes into recovery is associated with increased long-term risk of hypertension, according to the Journal of the American College of Cardiology 4, 5, 6

The American Heart Association recommends measuring BP at rest, peak exercise, and during recovery (at least at 2-3 minutes) when interpreting exercise stress tests 1, 2, 3
Comparing peak values to sex-specific thresholds (≥210 mm Hg men, ≥190 mm Hg women for systolic) is recommended by the American Heart Association 1, 2, 3
Assessing diastolic response (>10 mm Hg rise or ≥90 mm Hg absolute) and evaluating recovery patterns for failure to decline appropriately are also recommended by the American Heart Association 1, 2, 3
Consider terminating the test if systolic BP >250 mm Hg or diastolic BP >115 mm Hg, as recommended by the American Heart Association and supported by Circulation guidelines 1, 2, 3, 8