title: Assessing cutoff values for increased exercise blood pressure to predict incident hypertension in a general population.
abstract: OBJECTIVE
  Cutoff values for increased exercise blood pressure (BP) are not established in hypertension guidelines. The aim of the study was to assess optimal cutoff values for increased exercise BP to predict incident hypertension.
  
  
  METHODS
  Data of 661 normotensive participants (386 women) aged 25-77 years from the Study of Health in Pomerania (SHIP-1) with a 5-year follow-up were used. Exercise BP was measured at a submaximal level of 100 W and at maximum level of a symptom-limited cycle ergometry test. Cutoff values for increased exercise BP were defined at the maximum sum of sensitivity and specificity for the prediction of incident hypertension. The area under the receiver-operating characteristic curve (AUC) and net reclassification index (NRI) were calculated to investigate whether increased exercise BP adds predictive value for incident hypertension beyond established cardiovascular risk factors.
  
  
  RESULTS
  In men, values of 160  mmHg (100  W level; AUC = 0.7837; NRI = 0.534, P < 0.001) and 210  mmHg (maximum level; AUC = 0.7677; NRI = 0.340, P = 0.003) were detected as optimal cutoff values for the definition of increased exercise SBP. A value of 190  mmHg (AUC = 0.8347; NRI = 0.519, P < 0.001) showed relevance for the definition of increased exercise SBP in women at the maximum level.
  
  
  CONCLUSIONS
  According to our analyses, 190 and 210  mmHg are clinically relevant cutoff values for increased exercise SBP at the maximum exercise level of cycle ergometry test for women and men, respectively. In addition, for men, our analyses provided a cutoff value of 160  mmHg for increased exercise SBP at the 100  W level.
authors: aInstitute for Community Medicine bDepartment of Internal Medicine B cPulmonary Medicine, Weaning and Infectious Diseases and Scientific Division of Pneumology and Pneumological Epidemiology, University Medicine Greifswald dDZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
authors: Roberto
authors: R
authors: Lorbeer
authors: Till
authors: T
authors: Ittermann
authors: Henry
authors: H
authors: Völzke
authors: Sven
authors: S
authors: Gläser
authors: Ralf
authors: R
authors: Ewert
authors: Stephan B
authors: SB
authors: Felix
authors: Marcus
authors: M
authors: Dörr
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors