Exercise blood pressure, cardiorespiratory fitness and mortality risk

Peter Kokkinos, Charles Faselis, Labros Sidossis, Jiajia Zhang, Immanuel Babu Henry Samuel, Ali Ahmed, Pamela Karasik, Andreas Pittaras, Michael Doumas, Charalabos Grassos, Shirit Rosenberg, Jonathan Myers

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Objective: To assess the cardiorespiratory fitness (CRF) impact on the association between exercise blood pressure (BP) and mortality risk. Patients and methods: We assessed CRF in 15,004 US Veterans (mean age 57.5 ± 11.2 years) who completed a standardized treadmill test between January 1, 1988 and July 28, 2017 and had no evidence of ischemia. They were classified as Unfit or Fit according to the age-specific metabolic equivalents (METs) achieved <50% (6.2 ± 1.6 METs; n = 8440) or ≥ 50% (10.5 ± 2.4 METs; n = 6264). To account for the impact of resting systolic BP (SBP) on outcomes, we calculated the difference (Peak SBP-Resting SBP) and termed it SBP-Reserve. We noted a significant increase in mortality associated with SBP-Reserve ≤52 mmHg and stratified the cohort accordingly (SBP-Reserve ≤52 mmHg and > 52 mmHg). We applied multivariable Cox models to estimate hazard ratios (HR) and 95% confidence interval (CIs) for outcomes. Results: Mortality risk was significantly elevated only in Unfit individuals with SBP-Reserve ≤52 mmHg compared to those with SBP-Reserve >52 mmHg (HR = 1.35; CI: 1.24–1.46; P < 0.001). We then assessed the CRF and SBP-Reserve interaction on mortality risk with Fit individuals with SBP-Reserve >52 mmHg serving as the referent. Mortality risk was 92% higher (HR = 1.92%; 95% CI: 1.77–2.09; P < 0.001) in Unfit individuals with SBP-Reserve ≤52 mmHg and 47% higher (HR = 1.47; 95% CI: 1.33–1.62; P < 0.001) in those with SBP-Reserve >52 mmHg. Conclusion: Low CRF was associated with increased mortality risk regardless of peak exercise SBP. The risk was substantially higher in individuals unable to augment their exercise SBP >52 mmHg beyond resting levels.

Original languageEnglish (US)
Pages (from-to)11-17
Number of pages7
JournalProgress in Cardiovascular Diseases
StatePublished - Jul 2021

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


  • Blood pressure
  • Cardiorespiratory fitness
  • Exercise
  • Hypertension


Dive into the research topics of 'Exercise blood pressure, cardiorespiratory fitness and mortality risk'. Together they form a unique fingerprint.

Cite this