Reference Standards for Blood Pressure Response During Peak Exercise in Pediatric Patients with Structurally Normal Hearts

Hypertensive blood pressure (BP) response to exercise is a risk factor for the development of cardiovascular disease. Normative pediatric treadmill-based cardiopulmonary exercise test (CPET) BPs are not well established. We aimed to establish reference standards for CPET-derived BP response in children with structurally normal hearts. Retrospective analysis of 2,043 maximal effort Bruce protocol CPETs from patients ages 6-18 years without heart disease. Age- and sex-specific statistical analyses performed to determine BP percentile at peak exercise. A normal systolic blood pressure response (SBP) response to exercise was defined as < 90th percentile, elevated 90th-<95th percentile, and hypertensive ≥ 95th percentile for age- and sex-specific groups. Analysis of variance was performed to analyze differences between BP groups. Maximal exercise SBP percentile data were determined for age and sex specific groups. Peak exercise SBP is similar for males and females during childhood. In adolescence, males have higher peak SBP. Comparison amongst normal, elevated, and hypertensive CPET responses showed that patients with elevated and hypertensive responses to exercise had higher BMI and higher resting SBP. No significant differences in maximal heart rate or aerobic capacity based on peak exercise SBP. This study provides reference standards for BP response to peak exercise in pediatric and adolescent patients with structurally normal hearts using the Bruce protocol. The results help define pediatric BP responses to peak exercise and lay groundwork for future studies on prognostic significance of a pediatric hypertensive response to exercise.