Characteristics of post-exercise responders versus non-responders following aerobic or isometric exercise in physically inactive adults of African and South Asian descent with high-normal blood pressure or grade I hypertension.
Bersaoui M, Baldew S, et al. • Blood pressure • 2026
PEH following aerobic exercise is characterised by a distinct responder phenotype associated with greater reductions in aortic augmentation index and favourable cardiac adaptations, highlighting substantial interindividual variability in BP responses and supporting the need for individualised exercise strategies in hypertension management.
Key Findings
Results
Following aerobic exercise, 46% of participants were classified as systolic blood pressure responders compared with 28% after isometric handgrip exercise.
Sample: 47 physically inactive adults of African and South Asian descent living in Suriname (50.1 ± 10.8 years; 38% male)
Participants had high-normal BP or grade I hypertension
Responders were defined as those showing a net daytime BP decrease ≥5 mmHg (post-exercise minus pre-exercise, corrected for control condition)
Randomised controlled crossover trial with three conditions: aerobic exercise, isometric handgrip exercise, and non-exercise control
Results
No baseline differences in demographic or clinical characteristics were observed between responders and non-responders, suggesting PEH variability may reflect underlying physiological rather than clinical differences.
Responders and non-responders were compared on demographic and clinical characteristics at baseline
No statistically significant differences were found in any baseline demographic or clinical variable
This pattern was observed for both aerobic and isometric exercise conditions
Authors concluded that clinical profiling alone cannot identify likely responders prior to exercise
Results
Aerobic exercise responders demonstrated greater reductions in aortic augmentation index compared to non-responders.
Aortic augmentation index change: -19.4% in responders vs. -10.9% in non-responders (p = 0.05)
Aortic augmentation index is a marker of arterial stiffness and wave reflection
This difference was at the threshold of statistical significance
No consistent physiological differences in arterial stiffness parameters were observed following isometric exercise
Results
Aerobic exercise responders showed larger increases in stroke volume and cardiac output compared to non-responders.
Stroke volume change: +8.1 mL in responders vs. -5.3 mL in non-responders (p = 0.05)
Cardiac output change: +1.54 ± 1.89 L/min in responders vs. +0.58 ± 1.60 L/min in non-responders (p = 0.009)
Cardiac output change was the only variable associated with PEH magnitude across all variables examined (r = -0.46, p = 0.006)
Aerobic exercise responders also demonstrated more favourable autonomic recovery
Results
Among all physiological variables assessed, only the change in cardiac output was significantly associated with the magnitude of post-exercise hypotension.
Correlation coefficient: r = -0.46, p = 0.006
Variables assessed included arterial stiffness, cardiac parameters, and autonomic parameters
The negative correlation indicates that greater increases in cardiac output were associated with greater reductions in BP
This association was identified in the aerobic exercise condition
Results
No consistent physiological differences were observed between responders and non-responders following isometric handgrip exercise.
Isometric handgrip exercise produced a lower responder rate (28%) compared to aerobic exercise (46%)
The distinct physiological responder phenotype seen after aerobic exercise was not replicated after isometric exercise
Arterial stiffness, cardiac, and autonomic parameters were all assessed following isometric exercise
Authors concluded that different types of exercise do not have the same effect on blood pressure response patterns
Methods
The study protocol involved ambulatory blood pressure monitoring over 24 hours with post-exercise hypotension defined as the net effect corrected for a control condition.
Aerobic exercise consisted of 30 minutes at 40-60% heart rate reserve
Isometric exercise was isometric handgrip exercise
PEH was defined as: (post-exercise - pre-exercise) - (post-control - pre-control)
Participants were classified as responders if daytime BP decreased ≥5 mmHg
Arterial stiffness, cardiac, and autonomic parameters were assessed in addition to BP
What This Means
This research suggests that when people with elevated blood pressure exercise, roughly half experience a meaningful short-term drop in blood pressure afterward (called post-exercise hypotension), but this benefit is not universal. In a study of 47 physically inactive adults of African and South Asian descent living in Suriname who had high-normal or mildly elevated blood pressure, about 46% showed a significant blood pressure reduction after a 30-minute aerobic exercise session, while only 28% responded similarly after isometric handgrip exercise. Importantly, the researchers could not tell in advance who would respond based on basic characteristics like age, sex, or clinical measurements — responders and non-responders looked essentially the same before exercising.
The key differences between responders and non-responders emerged in how their bodies reacted during and after aerobic exercise. Responders showed more favorable changes in heart function — their hearts pumped more blood per beat and overall output increased more — and their arteries showed greater reductions in stiffness-related pressure. The change in how much blood the heart pumped per minute (cardiac output) was the single strongest predictor of who experienced a blood pressure drop. Responders also showed better recovery of the autonomic nervous system, which controls heart rate and blood vessel tone. None of these physiological differences were consistently seen after isometric handgrip exercise, suggesting the two exercise types work through different mechanisms and don't produce equivalent effects.
This research suggests that a 'one size fits all' exercise prescription for managing high blood pressure may be insufficient, since the cardiovascular and autonomic systems of different individuals respond in meaningfully different ways even to the same exercise bout. The findings point to a need for more personalized approaches to exercise in people with elevated blood pressure, potentially guided by how an individual's heart and blood vessels respond rather than by clinical measurements alone. The authors note that future research is needed to determine how these insights can be translated into practical, individualized exercise strategies to reduce cardiovascular risk.
Bersaoui M, Baldew S, van der Hilst K, Toelsie J, Cornelissen V. (2026). Characteristics of post-exercise responders versus non-responders following aerobic or isometric exercise in physically inactive adults of African and South Asian descent with high-normal blood pressure or grade I hypertension.. Blood pressure. https://doi.org/10.1080/08037051.2026.2717787