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Type-2 diabetes and the clinical importance of exaggerated exercise blood pressure


Schultz, MG and Otahal, P and Kovacevic, A-M and Roberts-Thomson, P and Stanton, T and Hamilton-Craig, C and Wahi, S and La Gerche, A and Hare, JL and Selvanayagam, J and Maiorana, A and Venn, AJ and Marwick, TH and Sharman, JE, Exercise Stress Test Collaboration (EXERTION) Investigators, Type-2 diabetes and the clinical importance of exaggerated exercise blood pressure, Hypertension, 79, (10) pp. 2346-2354. ISSN 0194-911X (2022) [Refereed Article]

Copyright Statement

2022 American Heart Association, Inc.

DOI: doi:10.1161/HYPERTENSIONAHA.122.19420


Background: Exaggerated exercise blood pressure (EEBP) during clinical exercise testing is associated with poor blood pressure (BP) control and cardiovascular disease (CVD). Type-2 diabetes (T2DM) is thought to be associated with increased prevalence of EEBP, but this has never been definitively determined and was the aim of this study.

Methods: Clinical exercise test records were analyzed from 13 268 people (aged 53+-13 years, 59% male) who completed the Bruce treadmill protocol (stages 1-4, and peak) at 4 Australian public hospitals. Records (including BP) were linked to administrative health datasets (hospital and emergency admissions) to define clinical characteristics and classify T2DM (n=1199) versus no T2DM (n=12 069). EEBP was defined as systolic BP >=90th percentile at each test stage. Exercise BP was regressed on T2DM history and adjusted for CVD and risk factors.

Results: Prevalence of EEBP (age, sex, preexercise BP, hypertension history, CVD history and aerobic capacity adjusted) was 12% to 51% greater in T2DM versus no T2DM (prevalence ratio [95% CI], stage 1, 1.12 [1.02-1.24]; stage 2, 1.51 [1.41-1.61]; stage 3, 1.25 [1.10-1.42]; peak, 1.18 [1.09-1.29]). 8.6% to 15.8% (4.8%-9.7% T2DM versus 3.5% to 6.1% no-T2DM) of people with 'normal' preexercise BP (<140/90 mm Hg) were identified with EEBP at stages 1 to 3. Exercise systolic BP relative to aerobic capacity (stages 1-4 and peak) was higher in T2DM with adjustment for all CVD risk factors.

Conclusions: People with T2DM have higher prevalence of EEBP and exercise systolic BP independent of CVD and many of its known risk factors. Clinicians supervising exercise testing should be alerted to increased likelihood of EEBP and thus poor BP control warranting follow-up care in people with T2DM.

Item Details

Item Type:Refereed Article
Keywords:blood pressure; hypertension; exercise; diabetes
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Schultz, MG (Dr Martin Schultz)
UTAS Author:Otahal, P (Mr Petr Otahal)
UTAS Author:Kovacevic, A-M (Mrs Ann-Marie Kovacevic)
UTAS Author:Venn, AJ (Professor Alison Venn)
UTAS Author:Sharman, JE (Professor James Sharman)
ID Code:153002
Year Published:2022
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-09-01
Last Modified:2022-11-21

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