Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for diagnosing systemic arterial hypertension (SAH) and for monitoring pharmacological treatment. Compared to office blood pressure (BP) measurements, ABPM offers greater predictive power and sensitivity for assessing cardiovascular outcomes – such as fatal and non-fatal coronary events and stroke – as well as target organ damage.^1,2 In routine cardiological evaluations, patients commonly undergo a treadmill exercise test, and if symptoms or an exaggerated blood pressure response to exertion are observed, ABPM is performed on the same day or shortly thereafter.

Aerobic exercise is known to reduce both systolic BP (SBP) and diastolic BP (DBP), with effects lasting up to 24 hours post-exercise.^3-6 However, it remains unclear whether a brief (<10 minutes), maximal or submaximal physical effort can influence blood pressure readings during hypertension assessment. Therefore, the present study aims to: (1) determine whether physical exertion affects ABPM results in individuals who undergo both tests on the same day; and (2) among those tested on the same day, assess whether the intensity reached during the treadmill test impacts the BP values recorded by ABPM.

Of the individuals eligible for the study during the data collection period, 18 were excluded due to having SBP ≥ 180 mmHg and/or DBP ≥ 110 mmHg prior to the exercise stress test, and six declined to participate. After the stress test, 83 individuals failed to reach at least the age-predicted submaximal heart rate, and 14 had electrocardiograms that were either uninterpretable or showed positive signs of myocardial ischemia (Figure 1). Thus, 190 patients were included in the final analysis, as shown in Table 1.

Figure 1

Table 1

Variable	Sample (n=190)
Sex (F/M)	88/102
Age (years)	53 ± 13
Weight (kg)	84.7 ± 18.3
Height (m)	1.70 ± 0.10
BMI (kg/m2)	29.2 ± 5.1
Exercise stress test
Heart rate (bpm)
Resting	77 ± 15
Maximum	154 ± 21
Blood pressure (mmHg)
Resting systolic blood pressure	131 ± 12
Maximum systolic blood pressure	161 ± 17
Resting diastolic blood pressure	82 ± 4
Maximum diastolic blood pressure	83 ± 7
Test duration (seconds)	333 ± 98

BMI: body mass index; bpm: beats per minute.

The comparison between performing ABPM and the exercise stress test on the same day versus on different days is presented in Table 2. No significant differences were observed in maximum SBP during wakefulness (p = 0.5307) or sleep (p = 0.7383), nor in maximum DBP during wakefulness (p = 0.2691) or sleep (p = 0.3974). Similarly, minimum SBP during wakefulness (p = 0.4615) and sleep (p = 0.5584), as well as minimum DBP during wakefulness (p = 0.1289) and sleep (p = 0.8075), did not differ significantly between the groups.

Table 2

Parameters/groups	Same day (n=145)	Different days (n=45)	p
Blood pressure values (mmHg)
Maximum systolic pressure during wakefulness	152 ± 17	155 ± 23	0.5307
Maximum systolic pressure during sleep	133 ± 16	134 ± 14	0.7383
Maximum systolic pressure during wakefulness	101 ± 13	104 ± 15	0.2691
Maximum systolic pressure during sleep	87 ± 13	89 ± 15	0.3974
Minimum systolic pressure during wakefulness	98 ± 13	100 ± 16	0.4615
Minimum systolic pressure during sleep	99 ± 13	100 ± 16	0.5584
Maximum systolic pressure during wakefulness	59 ±10	56 ± 13	0.1289
Maximum systolic pressure during sleep	56 ± 10	58 ± 13	0.8075

When comparing the intensity of physical effort among individuals who underwent both ABPM and the exercise stress test on the same day, no significant differences were observed in systolic blood pressure (SBP) during wakefulness (p = 0.1029) or sleep (p = 0.2149), nor in diastolic blood pressure (DBP) during wakefulness (p = 0.2062) or sleep (p = 0.1851) between the groups. Similar results were found for minimum SBP during wakefulness (p = 0.7964) and sleep (p = 0.8991), as well as for minimum DBP during wakefulness (p = 0.8864) and sleep (p = 0.4892), as shown in Table 3.

Table 3

Parameters/groups	Submaximal (n=95)	Maximum (n=50)	p
Blood pressure values (mmHg)
Maximum systolic pressure during wakefulness	155 ± 19	150 ± 15	0.1029
Maximum systolic pressure during sleep	134 ± 17	131 ± 15	0.2149
Maximum systolic pressure during wakefulness	103 ± 12	100 ± 13	0.2062
Maximum systolic pressure during sleep	89 ± 12	86 ± 14	0.1851
Minimum systolic pressure during wakefulness	98 ± 13	98 ± 13	0.7964
Minimum systolic pressure during sleep	98 ± 13	98 ± 13	0.8991
Maximum systolic pressure during wakefulness	59 ± 11	59 ± 11	0.8864
Maximum systolic pressure during sleep	57 ± 10	56 ± 10	0.4892

Following ABPM, 142 patients (75% of the sample) were diagnosed with arterial hypertension. Additionally, none of the participants in the study exhibited a hyper-reactive blood pressure response to exertion during the exercise stress test. ABPM data were also analyzed according to age groups (<65 years and ≥65 years) and sex, as presented in Table 4 of the supplementary material. Individuals aged ≥65 years showed significantly lower diastolic blood pressure during wakefulness (103 ± 13 vs. 96 ± 13 mmHg; p = 0.0015) compared to those under 65 years of age. No other variables showed significant differences between the groups analyzed.

Regarding sex differences, female participants showed lower diastolic blood pressure values compared to males in several parameters: maximum diastolic pressure during wakefulness (104 ± 13 vs. 99 ± 13 mmHg; p = 0.0053), maximum diastolic pressure during sleep (91 ± 14 vs. 84 ± 13 mmHg; p = 0.0012), minimum systolic pressure during wakefulness (101 ± 15 vs. 96 ± 12 mmHg; p = 0.0064), and minimum diastolic pressure during wakefulness (60 ± 12 vs. 55 ± 10 mmHg; p = 0.0019). The isolated analysis of ABPM within the same sex, comparing different days or the same day as the exercise stress test, did not show significant differences in the variables studied, as presented in Table 5 of the supplementary material.

Performing the treadmill test on the same day or on different days from ABPM did not influence blood pressure values in the studied sample, which consisted of non-hypertensive and physically inactive individuals. This finding supports the feasibility of conducting both the exercise stress test and ABPM on the same day, enhancing cardiological clinical practice by improving patient retention in the clinical setting and reducing dropout and discontinuity in clinical investigation.

The hypothesis, supported by a robust body of evidence, suggests that acute aerobic physical exercise reduces systolic and diastolic blood pressure, and that this effect may depend on the intensity of the exercise.^3-6

In treated hypertensive patients, physical exercise has been shown to reduce blood pressure for up to 24 hours, reaching values considered normal.⁶ However, in the present study, this effect was not observed – possibly because the population consisted of individuals who, although in the process of being diagnosed with hypertension, were not yet undergoing treatment. Additionally, the absence of this effect may be related to the low volume of exercise performed, with an average duration of five and a half minutes, corresponding to the length of the test.

Moreover, aside from the treadmill test, no participant engaged in any other form of physical exertion, there were no reports of alcohol consumption in the diaries, and the sample did not include night-shift workers, which could have introduced confounding factors into the results.

Following the age-based analysis (<65 years vs. ≥65 years), as expected, the heart rate achieved was lower in the older group due to the decline in cardiac function associated with aging.^7,8 Regarding male participants, higher hemodynamic values and longer test durations were observed.⁹ This finding is explained by greater physical capacity, resulting from higher testosterone levels and greater lean muscle mass.

The limitations of the present study include the absence of a group of hypertensive individuals and a group with hyper-reactivity to physical exertion, which would have allowed for more comprehensive comparisons and deeper exploration of the topic. The limited number of older participants, particularly those aged 65 and above, also restricts more detailed analyses, especially secondary analyses by sex, which could have enriched the discussion around a predominantly hypertensive population that requires specific cardiological care.

Performing the exercise stress test prior to ABPM, both conducted on the same day, did not influence blood pressure values when compared to individuals who underwent the tests on different days. Furthermore, in treadmill tests performed on the same day as ABPM, the intensity of effort, whether maximal or submaximal, did not affect the ABPM results.

Given the ability of physical exercise to reduce blood pressure, one of the objectives of this investigation was to determine whether this phenomenon could mask hypertension in adults. However, this effect was not observed, which aligns with the study’s hypothesis.

Therefore, the findings of this study reinforce clinical practice by demonstrating that physical exertion during the exercise stress test, whether submaximal or maximal, does not influence ABPM results, allowing both tests to be performed on the same day.