Elsevier

American Heart Journal

Volume 141, Issue 6, June 2001, Pages 1014-1017
American Heart Journal

Imaging and Diagnostic Testing
Reproducibility of exaggerated blood pressure response to exercise in healthy patients

https://doi.org/10.1067/mhj.2001.114197Get rights and content

Abstract

Background An exaggerated blood pressure response (ExBPR) to exercise has been shown to be predictive of future hypertension and left ventricular hypertrophy. The aim of this study was to test the reproducibility over time of ExBPR and to better characterize patients who consistently respond in this manner. Methods During periodical health examination, patients underwent routine treadmill exercise testing. ExBPR was said to be present if systolic blood pressure and/or diastolic blood pressure at peak exercise exceeded 200 mm Hg and 100 mm Hg, respectively. Over the past 25 years, 117 healthy patients with ExBPR performed 2 to 7 consecutive treadmill exercise tests. According to subsequent ExBPR, these patients were divided into a concordant group—those who had at least two-thirds repetitions of the ExBPR—and a discordant group—those who had less than two-thirds repetitions. For comparison, we identified patients who did not have ExBPR (control group). Results Of the 117 patients who had ExBPR, only 18 (15.4%) were in the concordant group in subsequent tests. No clinical features were found to characterize patients in the concordant group. In the two study groups, the variability of blood pressure measurements during stress was significantly greater than in the control group. Also, systolic blood pressure measurements at rest and after 3 minutes of recovery were significantly lower in the control group. Conclusions ExBPR to exercise is rarely reproducible, and there are no clinical findings characterizing those who consistently respond in this manner. Thus the prognostic importance of blood pressure response to exercise should be reconsidered. (Am Heart J 2001;141:1014-7.)

Section snippets

Study population

We conducted an observational, retrospective study.

The Israeli Defense Force maintains a periodical examination center for its personnel. Patients undergo medical check-ups at 3-year intervals. Aside from the stress testing, each examination includes a medical interview, physical examination, electrocardiography, and blood sampling for fasting glucose level and lipid profile. Stress test ergometry was performed in all patients >39 years of age and/or having ≥2 risk factors for cardiovascular

Baseline characteristics

When comparing the patients’ data between the groups at the time the first ExBPR occurred, the concordant group showed no characteristic feature (Table I).

. Baseline characteristics at the first time ExBPR occurred compared with control

ParameterConcordant group (n = 18)Discordant group (n = 99)Control group (n = 81)
Age (y)36.5 ± 2.836.8 ± 4.235 ± 4.1
BMI (kg/m2)25.5 ± 2.824.6 ± 2.924.2 ± 2.7
Fasting glucose (mg/dL)98.4 ± 23.588.9 ± 15.789.7 ± 16.7
Cholesterol (mg/dL)209 ± 33.7208.2 ± 39.4192.2 ± 43*

Discussion

Our study shows that for most of the patients with ExBPR, the high blood pressure measurements during stress are not reproducible. The change in SBP from rest to exercise also showed little reproducibility in the ExBPR responders. Those with consistent ExBPR are a relatively small number of patients who could not be distinguished by any clinically significant parameter, although SBP at rest and after 3 minutes of recovery was higher in both study groups than in the control group. Our findings,

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Reprint requests: Dr Yehonatan Sharabi, Internal Medicine D, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel. E-mail: [email protected]

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