It is well documented in large prospective epidemiological trials that high blood pressure at rest results in fatal and nonfatal cardiovascular events [
1]. There are conflicting data related with the prognostic importance of increased hypertensive response to exercise [
8‐
10], some data showed that exercise hypertension has an independent, adverse impact on outcome [
9,
10]. However, similar findings have not always been achieved [
8]. It has been suggested that blood pressure measured at maximal exercise is a better prognostic indicator than clinic pressure [
4]. It has been also shown in a recent comprehensive study that exercise hypertension is associated with a lower mortality rate [
11]. It has been shown in a large study that systolic pressure during exercise predicted total mortality independently of age; after additional adjustment for the pressure at sitting rest, only peak exercise pressure remained related to outcome; the adjusted diastolic exercise pressures did not predict mortality [
12]. In a shorter follow-up, totaling 1573 patient years, the prognostic significance of exercise blood pressure were assessed and concluded that blood pressure at 50 W, at 50% of peak exercise, and at peak workload did not add prognostic precision to the pressure at rest [
8]. But those findings have been disputed [
13,
14], but there are important differences between these studies and the previous report [
8]: a large number of healthy middle-aged men versus a smaller number of referred hypertensive patients; noninvasive versus intra-arterial blood pressure measurements; a short versus a longer period of rest before exercise; a relatively steep exercise protocol versus progressive graded multistage exercise, as conventionally used for clinical purposes; and differences in the studied end points and statistical methods. Analysis, based on continued follow-up of those hypertensive patients, supports the earlier conclusion [
8] that intra-arterial pressure at submaximal and peak bicycle exercise does not add prognostic precision to the pressure measured at rest before exercise, except for the small independent predictive value of peak systolic pressure for total mortality [
12]. Fagard et al. have explained why exercise blood pressure seems to provide independent prognostic information in healthy middle-aged men [
13,
14] and not in selected hypertensive patients. It is conceivable that the positive association between outcome and an excessive blood pressure elevation during exercise observed in the population-based samples resulted from an attenuated exercise-induced vasodilatation, as suggested previously [
14]. It can be argued that in contrast to hypertensive patients, healthy subjects have a normal cardiac output response to exercise. Consequently, an impaired reduction of systemic vascular resistance would not be opposed by a blunted rise of cardiac output and is therefore expressed in excessive blood pressure elevation. Regarding to that study; all-cause mortality was significantly related to intra-arterial pressure and systemic vascular resistance and not to cardiac output. The results are less consistent for the measurements during exercise, when only systemic vascular resistance at peak effort carried prognostic information over and above that of vascular resistance at rest. Moreover, the prognostic importance of vascular resistance was not opposed by cardiac output, so the prognostic precision of peak exercise pressure was independent of pressure at rest [
12].