exercise capacity and blood pressure associations with left ventricular mass in prehypertensive individuals prehypertensive individuals are at increased risk for developing hypertension and cardiovascular disease compared with those with normal blood pressure early compromises in left ventricular structure may explain part of the increased risk we assessed echocardiographic and exercise parameters in prehypertensive individuals n790 to determine associations between exercise blood pressure and left ventricular structure the exercise systolic blood pressure at 5 metabolic equivalents mets and the change in blood pressure from rest to 5 mets were the strongest predictors of left ventricular hypertrophy we identified the systolic blood pressure of 150 mm hg at the exercise levels of 5 mets as the threshold for left ventricular hypertrophy there was a 4fold increase in the likelihood for left ventricular hypertrophy for every 10mm hg increment in systolic blood pressure beyond this threshold or 115 95 ci 112 to 118 there was also a 42 reduction in the risk for left ventricular hypertrophy for every 1 met increase in the workload or 058 p0001 when compared with lowfit moderate and highfit individuals exhibited significantly lower systolic blood pressure at an exercise workload of 5 mets 15514 versus 14610 versus 14410 p005 lower left ventricular mass index 4812 versus 4110 versus 419 p005 and prevalence of left ventricular hypertrophy 483 versus 187 versus 216 p0001 this suggests that moderate improvements in cardiorespiratory fitness achieved by moderate intensity physical activity can improve hemodynamics and cardiac performance in prehypertensive individuals and reduce the work of the left ventricle ultimately resulting in lower left ventricular mass