Evidence map›Paper›PMID 41528824›Full record

ArticleEuropean heart journal2026

Exercise blood pressure relative to fitness and cardiovascular outcomes: the EXERTION study.

Martin G Schultz, Petr Otahal, Philip Roberts-Thomson, Tony Stanton, Christian Hamilton-Craig, Sudhir Wahi, Andre La Gerche, James L Hare, Joseph Selvanayagam, Andrew Maiorana and 3 more

Registry-linked trialAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07785765 (Norwegian Danish Spontaneous Coronary Artery Dissection Exercise Study), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07785765 naenrolling by invitationnot on this mapstarted 2027, after this paper: background citation

Norwegian Danish Spontaneous Coronary Artery Dissection Exercise Study

TypeinterventionalSponsorOslo University HospitalRan2027 to 2028Enrolled120ConditionsSpontaneous Coronary Artery Dissection, Myocardial Infarction (MI), High Intensity Interval TrainingArmsHigh intensity interval training (HIIT)
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Martin G SchultzMenzies Institute for Medical Research, University of Tasmania, Medical Science Precinct, 17 Liverpool Street, Hobart, Tasmania 7000, Australia.ORCID 0000-0003-3458-1811
Petr OtahalMenzies Institute for Medical Research, University of Tasmania, Medical Science Precinct, 17 Liverpool Street, Hobart, Tasmania 7000, Australia.
Philip Roberts-ThomsonDepartment of Cardiology, Royal Hobart Hospital, Hobart, Australia.
Tony StantonCardiology, Sunshine Coast University Hospital, Birtinya, Australia.
Christian Hamilton-CraigUniversity of Queensland, Brisbane, Australia.
Sudhir WahiDepartment of Cardiology, Princess Alexandra Hospital, Brisbane, Australia.
Andre La GercheBaker Heart and Diabetes Institute, Melbourne, Australia.ORCID 0000-0002-3906-3784
James L HareBaker Heart and Diabetes Institute, Melbourne, Australia.
Joseph SelvanayagamCardiac Imaging Research, Flinders University, Adelaide, Australia.
Andrew MaioranaCurtin School of Allied Health, Curtin University, Perth, Australia.
Alison J VennMenzies Institute for Medical Research, University of Tasmania, Medical Science Precinct, 17 Liverpool Street, Hobart, Tasmania 7000, Australia.
Thomas H MarwickMenzies Institute for Medical Research, University of Tasmania, Medical Science Precinct, 17 Liverpool Street, Hobart, Tasmania 7000, Australia.
James E SharmanMenzies Institute for Medical Research, University of Tasmania, Medical Science Precinct, 17 Liverpool Street, Hobart, Tasmania 7000, Australia.ORCID 0000-0003-2792-0811

Funding

Diabetes Australia Research Trust Project Grant Y19G-SHAJHeart Foundation of AustraliaHeart Foundation of Australia Future Leader FellowshipRoyal Hobart Hospital Research Foundation
6 · The paper itself

Abstract

BACKGROUND AND

aimsA hypertensive response to exercise is independently associated with cardiovascular disease (CVD), but clinical interpretation may be confounded by aerobic capacity (fitness). The aim of this study was to determine the relationship between exercise blood pressure (BP) relative to fitness and CVD events.

methodsClinical exercise test records were analysed from 12 743 people (aged 53 ± 13 years, 60% male) who completed a standard exercise stress test (Bruce treadmill protocol, stages 1-4) at six Australian hospitals. Records were linked to administrative datasets (hospital and emergency admissions, death register) to define clinical characteristics and the primary outcome of fatal/non-fatal CVD events. Exercise systolic BP relative to fitness was calculated from the quotient of systolic BP and peak METs (SBP/METPeak). Competing risks regression was undertaken to compare events across quartiles, at the 90th percentile, and at various thresholds of SBP/METPeak.

resultsOver a median follow-up of 51 months (interquartile range: 32-75 months), 1349 events occurred. Exercise systolic BP without consideration of fitness was not associated with cardiovascular events (P > .05). In models adjusted for age, sex, and pre-exercise systolic BP, there was a stepwise increase in cardiovascular events across SBP/METPeak quartiles at stages 1-3 and peak (fourth quarter hazard ratios [HR]: stage 1 HR 2.54, 95% confidence interval [CI] 2.08-3.12; stage 2 HR 2.05, 95% CI 1.64-2.57; stage 3 HR 1.60, 95% CI 1.22-2.10; peak HR 2.43, 95% CI 1.99-2.98). SBP/METPeak ≥90th percentile was associated with a 55-94% increased risk of cardiovascular events vs < 90th percentile (stages 1-3 and peak, P < .001). Thresholds from 15 to 24 mmHg/METPeak were associated with cardiovascular events in both males and females (P < .001, stages 1-3 and peak). Results persisted in those without CVD, normal pre-exercise BP, and in those on BP-lowering medication.

conclusionsExercise systolic BP relative to fitness is associated with increased risk for cardiovascular events and could provide a clinically actionable marker to prompt targeted intervention to lower hypertension-related cardiovascular risk.

Indexed as

Blood PressureCardiovascular DiseasesExercisePhysical FitnessAdultAgedExercise TestFemaleHumansHypertensionMaleMiddle AgedBlood pressure determinationCardiovascularDiagnostic techniquesExercise testsMortality determinant

Identifiers

PMID41528824
PMCPMC13058452

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.