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Войти в исследования Blood pressure · 2026
Waist-to-height ratio is the proximal correlate of workload-indexed exercise systolic blood pressure: a Czech preventive-cardiology cohort study.
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Puskasova Kristina, Jiravska-Godula Bogna, Samiec Jan, Jiravsky Otakar, Szotkowska Vendula, Kantor Marek, Wrobel Jana, Jakubovicova Eva, Rucki Stanislaw, Mohr Jan Alexander, Ranic Ivan, Pekar Matej, Spacek Radim, Chovancik Jan, Sovova Eliska
Аннотация
BACKGROUND: Exercise systolic blood-pressure (SBP) response predicts incident hypertension and cardiovascular events independent of resting BP, but guidelines disagree on the threshold for an exaggerated response and absolute peak-SBP cut-offs misclassify fit individuals. We examined determinants of workload-indexed exercise SBP and tested whether central adiposity statistically accounts for the cardiometabolic signal.
METHODS: Cross-sectional analysis of 324 working-age adults from a Czech preventive-cardiology cohort with a valid bicycle cardiopulmonary exercise test. The pre-specified primary endpoint was peak SBP indexed by relative workload (peak SBP ÷ W·kg-1). Confirmatory multivariable linear regression was fitted; statistical mediation of HOMA-IR and the triglyceride/HDL ratio through waist-to-height ratio (WHtR) was formally tested; binary outcomes were analysed under parallel ESC, AHA and workload-adjusted definitions.
RESULTS: WHtR was the dominant predictor (β = +8.96 mmHg per W·kg-1 per 1-SD, p < 0.001; R2 = 0.61) and remained significant across all eleven workload-indexing methods (including the SBP/MET slope and after VO2peak adjustment), and predicted peak SBP itself (p < 0.001). WHtR accounted for 80-90% of the effect of both insulin-resistance surrogates (Sobel p < 0.001). The association was age-modified (p = 0.014) and independent of sex (sex × WHtR p = 0.31). ESC and AHA definitions reclassified 47/324 patients (14.5%) discordantly (κ = 0.67). A workload-adjusted definition (SBP/MET slope > 10 mmHg·MET-1) classified 24.4% yet reclassified one in five versus ESC and showed no age dependence.
CONCLUSIONS: WHtR is the proximal anthropometric correlate of workload-indexed exercise SBP, statistically accounting for 80-90% of the insulin-resistance signal; the association is robust to the choice of workload-indexing method and largely independent of resting BP. ESC and AHA definitions classify approximately one in seven patients discordantly, motivating harmonisation.
METHODS: Cross-sectional analysis of 324 working-age adults from a Czech preventive-cardiology cohort with a valid bicycle cardiopulmonary exercise test. The pre-specified primary endpoint was peak SBP indexed by relative workload (peak SBP ÷ W·kg-1). Confirmatory multivariable linear regression was fitted; statistical mediation of HOMA-IR and the triglyceride/HDL ratio through waist-to-height ratio (WHtR) was formally tested; binary outcomes were analysed under parallel ESC, AHA and workload-adjusted definitions.
RESULTS: WHtR was the dominant predictor (β = +8.96 mmHg per W·kg-1 per 1-SD, p < 0.001; R2 = 0.61) and remained significant across all eleven workload-indexing methods (including the SBP/MET slope and after VO2peak adjustment), and predicted peak SBP itself (p < 0.001). WHtR accounted for 80-90% of the effect of both insulin-resistance surrogates (Sobel p < 0.001). The association was age-modified (p = 0.014) and independent of sex (sex × WHtR p = 0.31). ESC and AHA definitions reclassified 47/324 patients (14.5%) discordantly (κ = 0.67). A workload-adjusted definition (SBP/MET slope > 10 mmHg·MET-1) classified 24.4% yet reclassified one in five versus ESC and showed no age dependence.
CONCLUSIONS: WHtR is the proximal anthropometric correlate of workload-indexed exercise SBP, statistically accounting for 80-90% of the insulin-resistance signal; the association is robust to the choice of workload-indexing method and largely independent of resting BP. ESC and AHA definitions classify approximately one in seven patients discordantly, motivating harmonisation.