Blood pressure measurement during ergometric stress testing

Abstract

Evaluation of high blood pressure would be greatly facilitated by a standardized test procedure that could enable comparable and reproducible blood pressure determinations to be made. It would also be useful to have a standardized method for monitoring sympathetic activity, so that the occurrence and magnitude of inordinate stress responses could be assessed more accurately. One way to meet these requirements is through standardized ergometric testing at workloads of 50 to 100 watts using increments of 10 watts/ min or 25 watts/2 min (cuff blood pressure measurements). Between the ages of 20 and 50 years the criteria for a hypertensive response during exercise are blood pressure values of more than 200/100 mg Hg (mean + 1 SD of the normotensives) at a workload of 100 W. In the recovery phase, blood pressure is considered as being hypertensive if a value of 140/90 mm Hg is exceeded in the fifth minute. There are several studies showing that the blood pressure response to ergometry predicts future hypertension in patients with normal resting blood pressure. Patients suffering from mild hypertension showed significantly (p < 0.001) higher blood pressures (213 +/- 22/116 +/- 11 mm Hg) at 100 W and after exercise than age-matched normotensives (188 +/- 14/92 +/- 9 mm Hg) but significantly (p < 0.001) lower values than hypertensives with stable hypertension (225 +/- 22/126 +/- 11 mm Hg). Using the normal upper limits for blood pressure during and after ergometry, the ergometric procedure revealed that 50% of the patients with borderline hypertension at rest could be classified as hypertensives. Follow-up examinations several years (average 3.8 years) later subsequently showed that 97% of the ergometric-positive borderline hypertensives developed established hypertension. Ergometric studies also assume a prognostic importance, with respect to prevention of acute and chronic complications of hypertension. Therefore, we must require that antihypertensive drugs not only normalize the resting blood pressure, but also lower the blood pressure adequately in stressful situations. This requirement is by no means satisfied by all hypertensive drugs that are effective at rest.