How well do office and exercise blood pressures predict sustained hypertension? A Dundee Step Test Study

Abstract

Exercise systolic blood pressure (BP) appears to be a better predictor of cardiac mortality than casual office BP. We tested whether this could be explained by exercise systolic BP being a better predictor of sustained hypertension than casual office BP. Exercise systolic BP was measured using the lightweight 3-min single stage, submaximal Dundee Step Test in 191 consecutive subjects (102 male, age 52 (s.d. 13) years) who were referred to a specialist hypertension clinic for assessment. Exercise systolic BP was compared with office BP and daytime ambulatory BP (ABP). Sustained hypertension was defined as a mean daytime systolic and/or diastolic ABP of у140/90 mm Hg. Receiver operating characteristic (ROC) curves of exercise systolic BP and office BP in predicting sustained hypertension were compared. The positive predictive value of office diastolic BP у90 mm Hg and office systolic BP у140 mm Hg for sustained hypertension were 64% and 67%

Clinical importance of detecting exaggerated blood pressure response to exercise on antihypertensive therapy

“…First, on-treatment Ex-BP may reflect a higher BP during routine daily physical activity even if the BP at rest is well controlled, thereby increasing cardiac afterload and leading to reduced regression of LVH. This explanation is supported by several previous studies which observed that Ex-BP was a marker of higher ambulatory BP 15 19. Other studies have revealed that on-treatment LVM change is more closely related to change in 24-h BP than in clinic resting BP 20 21.…”

Blood Pressure and Left Ventricular Hypertrophy During American-Style Football Participation

“…Likely contributors include intraseason weight gain, changes in dietary caloric intake and sodium consumption, intrinsic familial predisposition to hypertension, and endothelial dysfunction. Recent data indicate that impaired endothelial function correlates with exaggerated exercise BP response, 28 a marker of increased mean ambulatory BP 29 and future hypertension risk in young adults. 30 It is therefore possible that the repetitive hemodynamic stress inherent in ASF participation results in endothelial dysfunction and corollary changes in resting vascular tone.…”

Blood pressure determinants of left ventricular wall thickness and mass index in hypertension: comparing office, ambulatory and exercise blood pressures

“…37 Indeed, the prognostic value of the submaximal ExSBP as a better predictor of cardiac death than OBP has been confirmed in a few large retrospective studies, [38][39][40] and a prospective study is currently on-going. 41 Furthermore, the ExSBP is a better marker than OBP in defining sustained hypertension 42 and we have also recently reported that apparently healthy hypertensives with a raised ExSBP had prolonged maximum heart rate corrected QT interval independent of LV mass. 43 The implication of our findings is that more attention should perhaps be given to ExSBP to help with risk stratification and as a modifiable risk factor in hypertensive patients.…”

“…Hence it has little biological relevance in comparison to BP measured at a lighter exercise workload which could be reliably measured noninvasively 9 and provides an indication of the level of 'active' BP during the day. 42 In contrast, it is difficult to know how best to define the maximal ExSBP, whether it is the highest BP reached during exercise, BP measured as an exercise is being terminated or immediately after stopping exercise. These distinctions were rarely made clear in previous studies.…”