{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T08:03:37Z","timestamp":1779264217094,"version":"3.51.4"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Hum Hypertens"],"DOI":"10.1038\/s41371-025-01089-3","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:51:50Z","timestamp":1761112310000},"page":"10-17","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic accuracy of different exercise blood pressure metrics in identifying hypertension on 24-h ambulatory blood pressure monitoring in athletes"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3176-6751","authenticated-orcid":false,"given":"Kristel","family":"Janssens","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7651-3740","authenticated-orcid":false,"given":"Stephen J.","family":"Foulkes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8459-2140","authenticated-orcid":false,"given":"Paolo","family":"D\u2019Ambrosio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1475-2222","authenticated-orcid":false,"given":"Amy M.","family":"Mitchell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie J.","family":"Rowe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3903-5051","authenticated-orcid":false,"given":"Youri","family":"Bekhuis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4153-9048","authenticated-orcid":false,"given":"Luke","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evelyn B.","family":"Parr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey A.","family":"Head","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hein","family":"Heidbuchel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Claessen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andre","family":"La Gerche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"1089_CR1","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1016\/S0140-6736(20)30752-2","volume":"396","author":"Collaborators GBDRF","year":"2020","unstructured":"Collaborators GBDRF. Global burden of 87 risk factors in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223\u201349.","journal-title":"Lancet"},{"key":"1089_CR2","doi-asserted-by":"publisher","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","volume":"45","author":"JW McEvoy","year":"2024","unstructured":"McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45:3912\u20134018.","journal-title":"Eur Heart J"},{"key":"1089_CR3","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1093\/eurjpc\/zwae012","volume":"31","author":"A Carlen","year":"2024","unstructured":"Carlen A, Lindow T, Cauwenberghs N, Elmberg V, Brudin L, Ekstrom M, et al. Exercise systolic blood pressure response during cycle ergometry is associated with future hypertension in normotensive individuals. Eur J Prev Cardiol. 2024;31:1072\u20139.","journal-title":"Eur J Prev Cardiol"},{"key":"1089_CR4","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/HJH.0000000000002991","volume":"40","author":"B Zafrir","year":"2022","unstructured":"Zafrir B, Aker A, Asaf Y, Saliba W. Blood pressure response during treadmill exercise testing and the risk for future cardiovascular events and new-onset hypertension. J Hypertens. 2022;40:143\u201352.","journal-title":"J Hypertens"},{"key":"1089_CR5","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","volume":"41","author":"G Mancia","year":"2023","unstructured":"Mancia G, Kreutz R, Brunstrom M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41:1874\u20132071.","journal-title":"J Hypertens"},{"key":"1089_CR6","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1249\/MSS.0000000000003569","volume":"57","author":"KD Currie","year":"2024","unstructured":"Currie KD, Schultz MG, Millar PJ, Pescatello LS. The role of exercise blood pressure in hypertension: measurement, mechanisms and management. Med Sci Sports Exerc. 2024;57:425\u201333.","journal-title":"Med Sci Sports Exerc"},{"key":"1089_CR7","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1161\/HYPERTENSIONAHA.117.10116","volume":"71","author":"A Sabbahi","year":"2018","unstructured":"Sabbahi A, Arena R, Kaminsky LA, Myers J, Phillips SA. Peak blood pressure responses during maximum cardiopulmonary exercise testing: reference standards from FRIEND (Fitness Registry and the Importance of Exercise: A National Database). Hypertension. 2018;71:229\u201336.","journal-title":"Hypertension"},{"key":"1089_CR8","doi-asserted-by":"publisher","first-page":"445","DOI":"10.4065\/71.5.445","volume":"71","author":"H Daida","year":"1996","unstructured":"Daida H, Allison TG, Squires RW, Miller TD, Gau GT. Peak exercise blood pressure stratified by age and gender in apparently healthy subjects. Mayo Clin Proc. 1996;71:445\u201352.","journal-title":"Mayo Clin Proc"},{"key":"1089_CR9","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1097\/CRD.0000000000000506","volume":"32","author":"C Ghidoni","year":"2024","unstructured":"Ghidoni C, Kruzik M, Rossi VA, Caselli S, Schmied CM, Niederseer D. Definitions for hypertensive response to exercise. Cardiol Rev. 2024;32:273\u20138.","journal-title":"Cardiol Rev"},{"key":"1089_CR10","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1093\/eurheartj\/ehy810","volume":"40","author":"S Caselli","year":"2019","unstructured":"Caselli S, Serdoz A, Mango F, Lemme E, Vaquer Segui A, Milan A, et al. High blood pressure response to exercise predicts future development of hypertension in young athletes. Eur Heart J. 2019;40:62\u20138.","journal-title":"Eur Heart J"},{"key":"1089_CR11","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1249\/JES.0000000000000276","volume":"50","author":"MG Schultz","year":"2022","unstructured":"Schultz MG, La Gerche A, Sharman JE. Cardiorespiratory fitness, workload, and the blood pressure response to exercise testing. Exerc Sport Sci Rev. 2022;50:25\u201330.","journal-title":"Exerc Sport Sci Rev"},{"key":"1089_CR12","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.ahj.2016.04.020","volume":"177","author":"S Caselli","year":"2016","unstructured":"Caselli S, Vaquer Segui A, Quattrini F, Di Gacinto B, Milan A, Assorgi R, et al. Upper normal values of blood pressure response to exercise in Olympic athletes. Am Heart J. 2016;177:120\u20138.","journal-title":"Am Heart J"},{"key":"1089_CR13","doi-asserted-by":"publisher","first-page":"1803","DOI":"10.1097\/HJH.0000000000001791","volume":"36","author":"A Pressler","year":"2018","unstructured":"Pressler A, Jahnig A, Halle M, Haller B. Blood pressure response to maximal dynamic exercise testing in an athletic population. J Hypertens. 2018;36:1803\u20139.","journal-title":"J Hypertens"},{"key":"1089_CR14","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1093\/eurjpc\/zwae262","volume":"32","author":"K Janssens","year":"2024","unstructured":"Janssens K, Foulkes SJ, Mitchell AM, Dausin C, Van Soest S, Spencer L, et al. Blood pressure response to graded bicycle exercise in males and females across the age and fitness spectrum. Eur J Prev Cardiol. 2024;32:43\u201351.","journal-title":"Eur J Prev Cardiol"},{"key":"1089_CR15","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1177\/2047487320909667","volume":"28","author":"K Hedman","year":"2021","unstructured":"Hedman K, Lindow T, Elmberg V, Brudin L, Ekstrom M. Age- and gender-specific upper limits and reference equations for workload-indexed systolic blood pressure response during bicycle ergometry. Eur J Prev Cardiol. 2021;28:1360\u20139.","journal-title":"Eur J Prev Cardiol"},{"key":"1089_CR16","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1007\/s00421-021-04656-x","volume":"121","author":"P Bauer","year":"2021","unstructured":"Bauer P, Kraushaar L, Dorr O, Nef H, Hamm CW, Most A. Sex differences in workload-indexed blood pressure response and vascular function among professional athletes and their utility for clinical exercise testing. Eur J Appl Physiol. 2021;121:1859\u201369.","journal-title":"Eur J Appl Physiol"},{"key":"1089_CR17","doi-asserted-by":"crossref","unstructured":"Schultz MG, Currie KD, Hedman K, Maiorana A, Climie RE, Littlechild D, et al. Exercise and Sports Science Australia (ESSA) - Consensus Statement: Exercise blood pressure for the identification of uncontrolled hypertension: recommendations to support best-practice blood pressure management. J Sci Med Sport. 2025.","DOI":"10.1016\/j.jsams.2025.05.011"},{"key":"1089_CR18","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1016\/j.jsams.2016.04.004","volume":"19","author":"MG Schultz","year":"2016","unstructured":"Schultz MG, Picone DS, Nikolic SB, Williams AD, Sharman JE. Exaggerated blood pressure response to early stages of exercise stress testing and presence of hypertension. J Sci Med Sport. 2016;19:1039\u201342.","journal-title":"J Sci Med Sport"},{"key":"1089_CR19","doi-asserted-by":"publisher","first-page":"e001309","DOI":"10.1136\/bmjsem-2022-001309","volume":"8","author":"R De Bosscher","year":"2022","unstructured":"De Bosscher R, Dausin C, Janssens K, Bogaert J, Elliott A, Ghekiere O, et al. Rationale and design of the PROspective ATHletic Heart (Pro@Heart) study: long-term assessment of the determinants of cardiac remodelling and its clinical consequences in endurance athletes. BMJ Open Sport Exerc Med. 2022;8:e001309.","journal-title":"BMJ Open Sport Exerc Med"},{"key":"1089_CR20","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1123\/ijspp.2021-0451","volume":"17","author":"AKA McKay","year":"2022","unstructured":"McKay AKA, Stellingwerff T, Smith ES, Martin DT, Mujika I, Goosey-Tolfrey VL, et al. Defining training and performance caliber: a participant classification framework. Int J Sports Physiol Perform. 2022;17:317\u201331.","journal-title":"Int J Sports Physiol Perform"},{"key":"1089_CR21","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1177\/2047487318763958","volume":"25","author":"ESCG de Souza","year":"2018","unstructured":"de Souza ESCG, Kaminsky LA, Arena R, Christle JW, Araujo CGS, Lima RM, et al. A reference equation for maximal aerobic power for treadmill and cycle ergometer exercise testing: analysis from the FRIEND registry. Eur J Prev Cardiol. 2018;25:742\u201350.","journal-title":"Eur J Prev Cardiol"},{"key":"1089_CR22","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/00126097-200410000-00007","volume":"9","author":"JD Cameron","year":"2004","unstructured":"Cameron JD, Stevenson I, Reed E, McGrath BP, Dart AM, Kingwell BA. Accuracy of automated auscultatory blood pressure measurement during supine exercise and treadmill stress electrocardiogram-testing. Blood Press Monit. 2004;9:269\u201375.","journal-title":"Blood Press Monit"},{"key":"1089_CR23","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1161\/CIR.0b013e31829b5b44","volume":"128","author":"GF Fletcher","year":"2013","unstructured":"Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128:873\u2013934.","journal-title":"Circulation"},{"key":"1089_CR24","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1136\/bjsports-2014-093976","volume":"49","author":"HM Berge","year":"2015","unstructured":"Berge HM, Isern CB, Berge E. Blood pressure and hypertension in athletes: a systematic review. Br J Sports Med. 2015;49:716\u201323.","journal-title":"Br J Sports Med"},{"key":"1089_CR25","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1152\/physrev.00035.2013","volume":"95","author":"MJ Joyner","year":"2015","unstructured":"Joyner MJ, Casey DP. Regulation of increased blood flow (hyperemia) to muscles during exercise: a hierarchy of competing physiological needs. Physiol Rev. 2015;95:549\u2013601.","journal-title":"Physiol Rev"},{"key":"1089_CR26","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1161\/ATVBAHA.122.318512","volume":"43","author":"M Nayor","year":"2023","unstructured":"Nayor M, Gajjar P, Murthy VL, Miller PE, Velagaleti RS, Larson MG, et al. Blood pressure responses during exercise: physiological correlates and clinical implications. Arterioscler Thromb Vasc Biol. 2023;43:163\u201373.","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"1089_CR27","doi-asserted-by":"publisher","DOI":"10.1111\/apha.13486","volume":"230","author":"O Skattebo","year":"2020","unstructured":"Skattebo O, Calbet JAL, Rud B, Capelli C, Hallen J. Contribution of oxygen extraction fraction to maximal oxygen uptake in healthy young men. Acta Physiol (Oxf). 2020;230:e13486.","journal-title":"Acta Physiol (Oxf)"},{"key":"1089_CR28","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/S0895-7061(03)01003-3","volume":"17","author":"KJ Stewart","year":"2004","unstructured":"Stewart KJ, Sung J, Silber HA, Fleg JL, Kelemen MD, Turner KL, et al. Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function. Am J Hypertens. 2004;17:314\u201320.","journal-title":"Am J Hypertens"},{"key":"1089_CR29","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1111\/j.1742-1241.2008.01922.x","volume":"63","author":"N Tzemos","year":"2009","unstructured":"Tzemos N, Lim PO, MacDonald TM. Exercise blood pressure and endothelial dysfunction in hypertension. Int J Clin Pract. 2009;63:202\u20136.","journal-title":"Int J Clin Pract"},{"key":"1089_CR30","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1080\/10641963.2020.1806292","volume":"43","author":"N Miyai","year":"2021","unstructured":"Miyai N, Shiozaki M, Terada K, Takeshita T, Utsumi M, Miyashita K, et al. Exaggerated blood pressure response to exercise is associated with subclinical vascular impairment in healthy normotensive individuals. Clin Exp Hypertens. 2021;43:56\u201362.","journal-title":"Clin Exp Hypertens"},{"key":"1089_CR31","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1177\/2047487319877268","volume":"27","author":"K Hedman","year":"2020","unstructured":"Hedman K, Cauwenberghs N, Christle JW, Kuznetsova T, Haddad F, Myers J. Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality. Eur J Prev Cardiol. 2020;27:978\u201387.","journal-title":"Eur J Prev Cardiol"},{"key":"1089_CR32","doi-asserted-by":"publisher","first-page":"284","DOI":"10.3109\/08037051.2011.566251","volume":"20","author":"MG Schultz","year":"2011","unstructured":"Schultz MG, Hare JL, Marwick TH, Stowasser M, Sharman JE. Masked hypertension is \u201cunmasked\u201d by low-intensity exercise blood pressure. Blood Press. 2011;20:284\u20139.","journal-title":"Blood Press"},{"key":"1089_CR33","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.015554","volume":"9","author":"J Lee","year":"2020","unstructured":"Lee J, Vasan RS, Xanthakis V. association of blood pressure responses to submaximal exercise in midlife with the incidence of cardiovascular outcomes and all-cause mortality: the framingham heart study. J Am Heart Assoc. 2020;9:e015554.","journal-title":"J Am Heart Assoc"}],"container-title":["Journal of Human Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41371-025-01089-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41371-025-01089-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41371-025-01089-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T08:12:57Z","timestamp":1768464777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41371-025-01089-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["1089"],"URL":"https:\/\/doi.org\/10.1038\/s41371-025-01089-3","relation":{},"ISSN":["1476-5527"],"issn-type":[{"value":"1476-5527","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]},"assertion":[{"value":"24 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was conducted following the Declaration of Helsinki and was approved by the Alfred Hospital Ethics Committee (333\/15 and 484\/16). The authors confirm that patient informed consent forms have been obtained for this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}