Background: Workload-indexed blood pressure response (wiBPR) to exercise was shown to be superior to peak systolic blood pressure (SBP) in predicting mortality in healthy men. Though, markers of wiBPR were not evaluated for athletes so far and the association with vascular function is unclear.

Methods: We examined 95 male professional athletes (26±5 y) and 30 male sedentary controls (26±4 y) in a cross sectional study. The workup included exercise testing via a graded cycle ergometer test. We assessed vascular functional parameters at rest, using transfer function-based analysis of peripheral arterial waveforms obtained via oscillometry. The SBP/W slope, SBP/MET slope, and SBP/W ratio at peak exercise were determined. Values for athletes were compared with those of controls.

Results: Athletes had a lower aortic pulse wave velocity (6.4±0.9 vs. 7.2±1.5 m/s, p=0.001) compared to controls. Maximum systolic BP (200±20 vs. 197±19 mmHg, p= 0.358) was not different, though athletes achieved a higher absolute and relative workload than controls (337±64 vs. 211±35 W; 3.72±0.8 vs. 2.5±0.5 W/kg, p<0.001). SBP/W slope (0.34±0.13 vs. 0.44±0.12 mmHg/W), SBP/MET slope (6.2±1.8 vs. 7.85±1.8 mmHg/MET) and peak SBP/W ratio (0.61±0.12 vs. 0.95±0.17 mmHg/W) were lower in athletes than in controls (p<0.001). Thus, vascular functional parameters were not able to predict the wiBPR in neither athletes nor controls.

Conclusion: The SBP/W and SBP/MET slope in athletes were comparable to the published reference values for the normal population, indicating their potential use in pre-participation screening of athletes. Thus, the peak SBP/W- ratio in athletes seems to be not meaningful comparable to the normative values of the general population and therefore should not be used in the interpretation of BPR in athletes. In contrast, the SBP/MET slope might be already used in male athletes to determine wiBPR to exercise. The newly proposed normative increase of 6.2 mmHg/MET may currently serve as threshold that has to be evaluated in different athletic populations. Further, its prognostic impact in athletes has to be proven. Thus, the markers of wiBPR could not be predicted with the measurement of vascular functional parameters at rest, despite their potential to detect occult cardiovascular impairment.