Clinical Hypertension · Nov 1, 2026

Exaggerated blood pressure response to exercise: bridging the gap between evidence and guidelines

By Cho IJ

An exaggerated blood pressure response to exercise (EBPR), also termed a hypertensive response to exercise, is a hyperdynamic phenotype in which blood pressure (BP) rises disproportionately during graded physical exertion. Over more than 3 decades, EBPR has been linked to incident hypertension, masked hypertension, subclinical target-organ damage, and adverse cardiovascular outcomes, largely independent of resting BP. Despite this consistent body of evidence, EBPR has yet to be formally recognized as a diagnostic or prognostic entity in major hypertension guidelines. This gap reflects not only the absence of a standardized definition and measurement protocol but also unresolved questions regarding its incremental diagnostic value beyond ambulatory and home BP monitoring and the specific clinical actions that should follow an abnormal response. This review summarizes the definitional and standardization challenges, the underlying pathophysiology, the clinical and prognostic implications, considerations in special populations, current approaches to assessment and management, and remaining challenges including the promise of submaximal, fitness-indexed measurement and emerging cuffless and wearable technologies.

doi.org/10.5646/ch.2026.32.e44Open accessPubMed 43011082Biomarkers