Exaggerated blood pressure response during exercise treadmill testing: functional and hemodynamic features, and risk factors

Abstract

The factors which contribute to an exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) are not wholly understood. The association between the insertion/deletion polymorphisms of the angiotensin-converting enzyme (ACE) and M235T of the angiotensinogen with EBPR during ETT still remains unstudied. To identify and compare the risk factors for hypertension between normotensive subjects with EBPR and those who exhibit a normal curve of blood pressure (BP) during ETT. In a series of EBPR cases from a historical cohort of normotensive individuals, a univariate analysis was performed to estimate the association of the studied factors with BP behavior during ETT. Additionally, logistic multivariate regression was conducted to analyze the joint effects of the variables. P-values above 0.05 were considered statistically significant. From a total of 10 027 analyzed examinations, only 219 met the criteria employed to define EBPR, which resulted in a prevalence of 12.6%. For the systolic component of the BP, hyperreactive subjects displayed a mean age and body mass index (BMI) significantly higher than the others (P¼0.002 and o0.001, respectively). No association was observed between the polymorphisms cited above and EBPR. An analysis of the joint effect of variables has indicated that only age (Po 0.001) and BMI (P¼0.001) were specifically associated with systolic BP during exercise. Age and BMI were the only factors that independently influenced EBPR during ETT.

Increased mean arterial pressure response to dynamic exercise in normotensive subjects with multiple metabolic risk factors

“…Such an effect might have a greater influence on vascular reactivity than on basal tone. [16][17][18][19] Therefore, although resting BP may not necessarily be high when the vascular impairment is not yet very severe, the vascular reactivity may already be abnormal, possibly resulting in excessive BP elevation under stressful conditions, for example, during physical exertion.…”

Exercise stress testing as the significant clinical modality for management of hypertension

“…Sympathetic tone is generally more activated in individuals with, than without, metabolic syndrome. Thus, the findings of Lima et al 4 in which age and BMI are significantly associated with exercise-induced hypertension or EBPR are logical and rational. Table 1 shows that the cumulative increase in mean systolic blood pressure among older adult men is larger in response to a work load expressed as a METS increase (work load progress).…”

“…However, they found no significant relationships. Others have found that the exercise-induced hypertension expressed as EBPR by Lima et al 4 correlates with subsequent cardiac events 5 in patients with cardiovascular diseases. In addition, a hypertensive blood pressure response to exercise in healthy individuals can predict the development of hypertension.…”

“…Lima et al 4 reported in this issue of Hypertension Research that age and body mass index (BMI) are significant predictors for an exaggerated blood pressure response (EBPR) during exercise stress testing. An EBPR is defined as an increase in delta systolic blood pressure of X7.5 mm Hg/ METS (metabolic equivalents) and/or systolic blood pressure at the peak of the exercise exceeding 220 mm Hg or a delta diastolic blood pressure increase of X15 mm Hg compared with resting values.…”

“…Prospective clinical studies should be performed, such as follow-up of hypertensive patients and healthy individuals with EBPR, to determine the significance of EBPR for predicting the development of organ damage or untoward outcomes. From this aspect, the recent report by Lima et al 4 published in the Journal of 'Hypertension Research' is very valuable.…”