Women More Prone to Exaggerated Blood Pressure Response During Exercise Than Men, reveals study

“We found that exaggerated systolic blood pressure response (ESBPR) was more common in women (10.1%) than in men (1.9%). Among women, those over 51 were nearly twice as likely to exhibit ESBPR, with age emerging as a stronger predictor in women than in men,” the researchers reported. “While younger men (18–44 years) had peak systolic blood pressure approximately 12 mmHg higher than women, this gap narrowed considerably after the age of 45."

The American Heart Association currently defines exaggerated systolic blood pressure response to exercise (ESBPR) using sex-specific thresholds—≥210 mmHg for men and ≥190 mmHg for women. These cutoffs, however, are primarily derived from younger, healthy individuals, raising questions about their relevance across broader, real-world populations.

To explore this, the researchers examined 44,418 individuals (40.6% women) with a mean age of 49 years, who underwent treadmill exercise testing between 2016 and 2022. The findings revealed the following:

• ESBPR was significantly more prevalent in women than in men, with rates of 10.1% and 1.9% respectively.
• Among younger individuals (aged 18–44), men had peak systolic blood pressure values approximately 12 mmHg higher than women.
• This sex-based difference in peak SBP diminished with age, narrowing to less than 4 mmHg in individuals aged 45 and above.
• Age emerged as a strong predictor of ESBPR in women, but not in men, according to the stratified multivariate regression analysis.
• Women aged 51 and above, used as a proxy for postmenopausal status, were nearly twice as likely to experience ESBPR compared to younger women (adjusted OR: 1.904).

These findings suggest that the current lower ESBPR threshold for women might lead to overdiagnosis, particularly among postmenopausal women, who appear more prone to being flagged for an exaggerated BP response based on existing criteria.

According to the authors, this study emphasizes the importance of reevaluating exercise blood pressure thresholds with age and sex in mind. The observed discrepancies raise important clinical implications for the diagnosis and management of cardiovascular risk, particularly in women transitioning through menopause.

The authors concluded, "The large-scale, real-world clinical analysis reveals that sex and age significantly influence systolic blood pressure response to exercise. It calls into question whether current definitions of ESBPR adequately reflect these nuances, particularly in women, and highlights the need for more tailored diagnostic criteria in cardiovascular care."

Reference:

Li, S., Zhang, T., He, J., He, C., Liu, F., Yao, Y., Li, X., Hui, R., & Fan, X. (2025). Sex differences in systolic blood pressure response to exercise testing: A real-world clinical analysis. Journal of Human Hypertension, 1-7. https://doi.org/10.1038/s41371-025-01037-1