Abnormal Blood Pressure Response to Excercise in Borderline Hypertension: A Two Year Follow-up Study

Abstract

Twenty-eight men with borderline hypertension according to the World Health Organization criteria underwent maximal exercise testing, and then were followed for a two year period. The prevalence of abnormal blood pressure behavior during exercise was 53.58% (n = 15). During follow-up established hypertension developed in 63.33% (n = 10) of subjects with an abnormal blood pressure response to exercise, and only in 15% (n = 2) of subjects with normal blood pressure behavior. In predicting established hypertension development in a two year follow-up, maximal exercise testing has the following statistical values: sensitivity = 83.33%, specificity = 68.75%, accuracy = 75%, positive predictive value = 66.66%, negative predictive value = 84.61%.

Can blood pressure responses to tests unmask future blood pressure trends and the need for antihypertensive medication? Ten years of follow‐up

“…Both isometric (Parker et al, 1987;Chaney & Eyman, 1988;Matthews et al, 1993) and dynamic (Dlin et al, 1983;Chaney & Eyman, 1988;Wilson et al, 1990;Guerrera et al, 1991;Manolio et al, 1994;Allison et al, 1999;Singh et al, 1999;Miyai et al, 2000) exercise tests have also in the previous studies signi®cantly predicted BP trends and target-organ damage. Both isometric (Parker et al, 1987;Chaney & Eyman, 1988;Matthews et al, 1993) and dynamic (Dlin et al, 1983;Chaney & Eyman, 1988;Wilson et al, 1990;Guerrera et al, 1991;Manolio et al, 1994;Allison et al, 1999;Singh et al, 1999;Miyai et al, 2000) exercise tests have also in the previous studies signi®cantly predicted BP trends and target-organ damage.…”

“…In addition to BPs in the postural tests, some of the BPs at the exercise tests in the present study were more predictive than the casual BP measurements alone. Both isometric (Parker et al, 1987;Chaney & Eyman, 1988;Matthews et al, 1993) and dynamic (Dlin et al, 1983;Chaney & Eyman, 1988;Wilson et al, 1990;Guerrera et al, 1991;Manolio et al, 1994;Allison et al, 1999;Singh et al, 1999;Miyai et al, 2000) exercise tests have also in the previous studies signi®cantly predicted BP trends and target-organ damage. In contrast to previous studies using only few tests, this follow-up allows the comparison of both isometric and dynamic exercise tests to postural tests as predictors in the same study.…”

“…We could show, that the BP levels achieved during the tests provided additional bene®t compared with the casual BP measurements in predicting the subjects' BP trends and need for antihypertensive medication, while the BP changes from the reference level were not predictive. There is a variation in methodology in previous studies, most of them using either BP levels achieved in the tests (Dlin et al, 1983;Fixler et al, 1985;Radice et al, 1985;Chaney & Eyman, 1988;Tanji et al, 1989;Wilson et al, 1990;Guerrera et al, 1991;Manolio et al, 1994;Allison et al, 1999;Singh et al, 1999) or changes from the reference BP level (Sparrow et al, 1986;Matthews et al, 1993;Everson et al, 1996;Miyai et al, 2000) in predicting BP trends. Before the present study, we are aware of only one study using both analysing methods in predicting future BP (Parker et al, 1987).…”

“…Is it possible to unmask those prone to become hypertensives by using BP measurements under test conditions? Indeed, several studies have shown that an excessive increase in BP during dynamic exercise may be a marker of future BP trends (Dlin et al, 1983;Manolio et al, 1994) or hypertension (Chaney & Eyman, 1988;Wilson et al, 1990;Guerrera et al, 1991;Allison et al, 1999;Singh et al, 1999;Miyai et al, 2000) and an increased risk of cardiovascular morbidity (Allison et al, 1999) and mortality (Filipovsky et al, 1992;Mundal et al, 1994). Everson et al (1996) were the ®rst to show an association between the anticipatory BP response to dynamic exercise test and incident hypertension or high BP in an unselected population.…”

Coronary Collateral Flow and Hypertensive Response in the Exercise Test

“…Studies have suggested that an exaggerated blood pressure response to maximal exercise may be useful in detecting individuals who are prone to developing hypertension in late years. Guerrera et al [1] found in a 2-year follow-up that maximal exercise testing had a sensitivity of 83.33%, specificity of 68.75%, positive predictive value of 66.66% and a negative pedictive value of 84.61% in predicting established hypertension development. In the same way, Fagard et al [2] suggested that intra-arterial pressures at rest and during submaximal and peak exercise significantly predict mortality and the incidence of cardiovascular events in hypertensive men.…”