Waist-to-height ratio is the proximal correlate of workload-indexed exercise systolic blood pressure: a Czech preventive-cardiology cohort study.

Authors

Kristina Puskasova, Bogna Jiravska-Godula, Jan Samiec, Otakar Jiravsky, Vendula Szotkowska, Marek Kantor, Jana Wrobel, Eva Jakubovicova, Stanislaw Rucki, Jan Alexander Mohr, Ivan Ranic, Matej Pekar, Radim Spacek, Jan Chovancik, Eliska Sovova

Published in

Blood pressure. Pages 1-22. Aug 20, 2026. Epub Aug 20, 2026.

Abstract

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. Robustness to the workload denominator was tested across eleven indexing methods.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), so the association is not a denominator artefact. 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.

PMID:
42622378
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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