{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T12:20:36Z","timestamp":1781353236019,"version":"3.54.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V104C-172"],"award-info":[{"award-number":["V104C-172"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V104E12-003-MY3"],"award-info":[{"award-number":["V104E12-003-MY3"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V108E-004-5"],"award-info":[{"award-number":["V108E-004-5"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V109E-008-"],"award-info":[{"award-number":["V109E-008-"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V109C-134"],"award-info":[{"award-number":["V109C-134"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011912","name":"Taipei Veterans General Hospital","doi-asserted-by":"publisher","award":["V110C-131"],"award-info":[{"award-number":["V110C-131"]}],"id":[{"id":"10.13039\/501100011912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 103-2314-B-010-050-MY2"],"award-info":[{"award-number":["MOST 103-2314-B-010-050-MY2"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007225","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["MOST 106-2314-B-075-047-MY2"],"award-info":[{"award-number":["MOST 106-2314-B-075-047-MY2"]}],"id":[{"id":"10.13039\/100007225","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008903","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["MOHW111-TDU-B-211-134001"],"award-info":[{"award-number":["MOHW111-TDU-B-211-134001"]}],"id":[{"id":"10.13039\/100008903","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008903","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["MOHW112-TDU-B-211-144001"],"award-info":[{"award-number":["MOHW112-TDU-B-211-144001"]}],"id":[{"id":"10.13039\/100008903","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008903","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["MOHW113-TDU-B-211-114007"],"award-info":[{"award-number":["MOHW113-TDU-B-211-114007"]}],"id":[{"id":"10.13039\/100008903","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Death Registry"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic significance of BP changes during exercise remains unclear. This study investigated the association between exercise-related BP and long-term mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 19,110 individuals (mean age 57.9 years, 61.9% men) who underwent clinically indicated treadmill exercise testing. The recordings of BP throughout the test were obtained, and maximal and recovery changes in SBP (\u0394SBPmax and \u0394SBPrec) were calculated. Mortality and cardiovascular (CV) death were obtained via linkage to the National Death Registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a mean follow-up of 4.4\u2009\u00b1\u20092.6 years, there were 649 deaths and 134 CV deaths. Higher resting SBP, recovery SBP, maximal exercise SBP, peak heart rate, \u0394SBPmax, and \u0394SBPrec were inversely associated with CV and all-cause mortality. In contrast, a drop in recovery SBP below resting levels was associated with higher mortality. After multivariable adjustment for age, sex, lipid profiles, diabetes, use of antihypertensive agents, resting SBP, and metabolic equivalents, both \u0394SBPmax and \u0394SBPrec remained independently predictive. Specifically, for per 1-SD increase, \u0394SBPmax was associated with a hazard ratio (HR) of 0.80 (95% CI, 0.67-0.97) for CV death and 0.88 (95% CI, 0.80-0.96) for all-cause death. Similarly, \u0394SBPrec was associated with an HR of 0.75 (95% CI, 0.62-0.90) for CV death and 0.85 (95% CI, 0.77-0.93) for all-cause death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Greater SBP increases during exercise and recovery were associated with lower CV and all-cause mortality, while a drop in recovery SBP identified elevated risk. Exercise BP responses may serve as simple, clinically relevant prognostic markers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpaf184","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T11:41:43Z","timestamp":1759837303000},"page":"214-222","source":"Crossref","is-referenced-by-count":1,"title":["Differential Impacts of Resting and Exercise-related Blood Pressure Changes on Cardiovascular and All-cause Mortalities"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6423-4242","authenticated-orcid":false,"given":"Dan-Ying","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]},{"name":"Division of Cardiology, Department of Medicine, National Yang-Ming Chiao-Tung University Hospital , Yilan,","place":["Taiwan"]},{"name":"Department of Internal Medicine, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Jung","family":"Huang","sequence":"additional","affiliation":[{"name":"Center for Evidence-based Medicine, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]},{"name":"Department of Medical Education, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Huan","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]},{"name":"Department of Internal Medicine, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]},{"name":"Department of Medical Education, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]},{"name":"Cardiovascular Research Center, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1151-1047","authenticated-orcid":false,"given":"Chern-En","family":"Chiang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]},{"name":"Cardiovascular Research Center, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]},{"name":"General Clinical Research Center, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao-Min","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]},{"name":"Center for Evidence-based Medicine, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]},{"name":"Department of Medical Education, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]},{"name":"Cardiovascular Research Center, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]},{"name":"General Clinical Research Center, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9441-1836","authenticated-orcid":false,"given":"Shih-Hsien","family":"Sung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital , Taipei,","place":["Taiwan"]},{"name":"Department of Internal Medicine, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]},{"name":"Cardiovascular Research Center, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]},{"name":"Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University College of Medicine , Taipei,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"2026020915220640600_hpaf184-B1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1056\/NEJMoa1803180","article-title":"Effect of systolic and diastolic blood pressure on cardiovascular outcomes","volume":"381","author":"Flint","year":"2019","journal-title":"N Engl J Med"},{"key":"2026020915220640600_hpaf184-B2","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1016\/S0140-6736(02)11911-8","article-title":"Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies","volume":"360","author":"Lewington","year":"2002","journal-title":"Lancet"},{"key":"2026020915220640600_hpaf184-B3","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1016\/j.jacc.2015.08.015","article-title":"Clinical relevance of exaggerated exercise blood pressure","volume":"66","author":"Schultz","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2026020915220640600_hpaf184-B4","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1016\/j.amjcard.2007.06.070","article-title":"Prognostic significance of systolic blood pressure increases in men during exercise stress testing","volume":"100","author":"Gupta","year":"2007","journal-title":"Am J Cardiol"},{"key":"2026020915220640600_hpaf184-B5","first-page":"328","article-title":"ACSM\u2019s Guidelines for Exercise Testing and Prescription 9th Ed. 2014","volume":"58","author":"Ferguson","year":"2014","journal-title":"J Can Chiropr Assoc"},{"key":"2026020915220640600_hpaf184-B6","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.atherosclerosis.2014.08.029","article-title":"Low exercise blood pressure and risk of cardiovascular events and all-cause mortality: systematic review and meta-analysis","volume":"237","author":"Barlow","year":"2014","journal-title":"Atherosclerosis"},{"key":"2026020915220640600_hpaf184-B7","doi-asserted-by":"crossref","first-page":"218","DOI":"10.3109\/07853890.2011.560180","article-title":"Blood pressure responses during exercise testing-is up best for prognosis?","volume":"44","author":"Laukkanen","year":"2012","journal-title":"Ann Med"},{"key":"2026020915220640600_hpaf184-B8","doi-asserted-by":"crossref","first-page":"e0144935","DOI":"10.1371\/journal.pone.0144935","article-title":"Heart rate variability is associated with exercise capacity in patients with cardiac syndrome X","volume":"11","author":"Lu","year":"2016","journal-title":"PLoS One"},{"key":"2026020915220640600_hpaf184-B9","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1253\/circj.CJ-15-0588","article-title":"Additive value of heart rate variability in predicting obstructive coronary artery disease beyond Framingham risk","volume":"80","author":"Li","year":"2016","journal-title":"Circ J"},{"key":"2026020915220640600_hpaf184-B10","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1016\/S0735-1097(02)02164-2","article-title":"ACC\/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines)","volume":"40","author":"Gibbons","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2026020915220640600_hpaf184-B11","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S0735-1097(00)01054-8","article-title":"Age-predicted maximal heart rate revisited","volume":"37","author":"Tanaka","year":"2001","journal-title":"J Am Coll Cardiol"},{"key":"2026020915220640600_hpaf184-B12","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1161\/HYPERTENSIONAHA.111.00569","article-title":"White coat hypertension is more risky than prehypertension: important role of arterial wave reflections","volume":"61","author":"Sung","year":"2013","journal-title":"Hypertension"},{"key":"2026020915220640600_hpaf184-B13","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1161\/CIRCULATIONAHA.109.895292","article-title":"Exercise blood pressure and future cardiovascular death in asymptomatic individuals","volume":"121","author":"Weiss","year":"2010","journal-title":"Circulation"},{"key":"2026020915220640600_hpaf184-B14","doi-asserted-by":"crossref","first-page":"445","DOI":"10.4065\/71.5.445","article-title":"Peak exercise blood pressure stratified by age and gender in apparently healthy subjects","volume":"71","author":"Daida","year":"1996","journal-title":"Mayo Clin Proc"},{"key":"2026020915220640600_hpaf184-B15","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1161\/01.HYP.0000148460.95060.f2","article-title":"Systolic blood pressure during recovery from exercise and the risk of acute myocardial infarction in middle-aged men","volume":"44","author":"Laukkanen","year":"2004","journal-title":"Hypertension"},{"key":"2026020915220640600_hpaf184-B16","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1136\/hrt.2008.162172","article-title":"Augmented blood pressure response to exercise is associated with improved long-term survival in older people","volume":"95","author":"Hedberg","year":"2009","journal-title":"Heart"},{"key":"2026020915220640600_hpaf184-B17","doi-asserted-by":"crossref","first-page":"689","DOI":"10.7326\/0003-4819-118-9-199305010-00005","article-title":"Prediction of cardiovascular death in men undergoing noninvasive evaluation for coronary artery disease","volume":"118","author":"Morrow","year":"1993","journal-title":"Ann Intern Med"},{"key":"2026020915220640600_hpaf184-B18","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S0735-1097(86)80089-4","article-title":"Relative value of clinical variables, bicycle ergometry, rest radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring at discharge to predict 1 year survival after myocardial infarction","volume":"8","author":"Fioretti","year":"1986","journal-title":"J Am Coll Cardiol"},{"key":"2026020915220640600_hpaf184-B19","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0735-1097(87)80156-0","article-title":"Exercise response of the systolic pressure to end-systolic volume ratio in patients with coronary artery disease","volume":"10","author":"Gibbons","year":"1987","journal-title":"J Am Coll Cardiol"},{"key":"2026020915220640600_hpaf184-B20","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1038\/ajh.2011.75","article-title":"Association of masked hypertension and left ventricular remodeling with the hypertensive response to exercise","volume":"24","author":"Sharman","year":"2011","journal-title":"Am J Hypertens"},{"key":"2026020915220640600_hpaf184-B21","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1038\/ajh.2008.166","article-title":"Patients with type 2 diabetes have exaggerated brachial and central exercise blood pressure: relation to left ventricular relative wall thickness","volume":"21","author":"Scott","year":"2008","journal-title":"Am J Hypertens"},{"key":"2026020915220640600_hpaf184-B22","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jash.2007.11.002","article-title":"Exaggerated exercise blood pressure response is related to tissue Doppler imaging estimated diastolic dysfunction in the early stages of hypertension","volume":"2","author":"Tsioufis","year":"2008","journal-title":"J Am Soc Hypertens"},{"key":"2026020915220640600_hpaf184-B23","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/0002-9149(90)91139-W","article-title":"Exaggerated pressure response to exercise in men at risk for systemic hypertension","volume":"66","author":"Wilson","year":"1990","journal-title":"Am J Cardiol"},{"key":"2026020915220640600_hpaf184-B24","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/S0735-1097(01)01743-0","article-title":"Hypertensive response to exercise: a potential cause for new wall motion abnormality in the absence of coronary artery disease","volume":"39","author":"Ha","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2026020915220640600_hpaf184-B25","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1161\/01.CIR.78.6.1380","article-title":"Exercise-induced hypotension in a male population. Criteria, causes, and prognosis","volume":"78","author":"Dubach","year":"1988","journal-title":"Circulation"},{"key":"2026020915220640600_hpaf184-B26","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/S0002-8703(05)80015-8","article-title":"Prognostic value of abnormal postexercise systolic blood pressure response: prehospital discharge test after myocardial infarction in Japan","volume":"119","author":"Kato","year":"1990","journal-title":"Am Heart J"},{"key":"2026020915220640600_hpaf184-B27","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1161\/01.RES.56.4.586","article-title":"Optimal arterial resistance for the maximal stroke work studied in isolated canine left ventricle","volume":"56","author":"Sunagawa","year":"1985","journal-title":"Circ Res"},{"key":"2026020915220640600_hpaf184-B28","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1161\/hc3901.095960","article-title":"Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association","volume":"104","author":"Fletcher","year":"2001","journal-title":"Circulation"},{"key":"2026020915220640600_hpaf184-B29","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1001\/archinte.1992.00400170089017","article-title":"Clinical significance of early vs late hypotensive blood pressure response to treadmill exercise","volume":"152","author":"Watson","year":"1992","journal-title":"Arch Intern Med"}],"container-title":["American Journal of Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajh\/advance-article-pdf\/doi\/10.1093\/ajh\/hpaf184\/64546955\/hpaf184.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/39\/2\/214\/64546955\/hpaf184.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajh\/article-pdf\/39\/2\/214\/64546955\/hpaf184.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T20:22:19Z","timestamp":1770668539000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajh\/article\/39\/2\/214\/8277546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,8]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,10,8]]},"published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ajh\/hpaf184","relation":{},"ISSN":["0895-7061","1941-7225"],"issn-type":[{"value":"0895-7061","type":"print"},{"value":"1941-7225","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,10,8]]}}}