Is hypertensive response in treadmill testing better identified with correction for working capacity? A study with clinical, echocardiographic and ambulatory blood pressure correlates

Abstract

Hypertensive response in treadmill testing is associated with the development of hypertension, but it is still unclear if it is better identified by systolic or diastolic response, and measured directly or corrected by working capacity. We investigated 75 patients with normal office blood pressure through a treadmill testing, ambulatory blood pressure (ABP) monitoring, and two-dimensional Doppler echocardiogram. Characteristics associated with systolic blood pressure (SBP) response corrected by the estimated metabolic equivalent (MET) were identified in multiple linear regression models. SBP response was associated more consistently with age, body mass index (BMI), systolic ABP and left ventricular posterior wall thickness (p < 0.001) than diastolic response in the bivariate analysis, especially when corrected by MET. Age, BMI and nightly SBP were independently associated with SBP response corrected by MET in the multivariate analysis. Individuals from the top tertile of SBP response corrected by MET (> or =11.3 mmHg/MET) were older and had higher BMI, ABP and left ventricular septal and posterior wall thickness than individuals classified in the lower tertiles. These differences were more pronounced than the differences observed between individuals with and without a peak exercise blood pressure higher than 210 mmHg. We concluded that individuals with a high blood pressure response in treadmill testing have higher BMI, left ventricular posterior wall thickness and SBP measured by ABP monitoring than individuals without such a response. These differences were stronger when the variation of blood pressure during exercise was corrected by the amount of work performed.

Correction of the hypertensive response in the treadmill testing by the work performance improves the prediction of hypertension by ambulatory blood pressure monitoring and incidence of cardiac abnormalities by echocardiography: Results of an eight year follow-up study

“…They consisted of tertiles of the deltas between pre-exercise resting blood pressure and the peak exercise blood pressure in the ETT corrected by MET. Only the systolic response was included in the follow-up analysis, since the diastolic response was less consistently associated with ABPM and echocardiographic parameters in the baseline evaluation [17]. Office blood pressure, 24 h, daily and nightly ABP, and echocardiographic parameters in the follow-up examination by tertiles of blood pressure response by MET were tested by means of two-way ANOVA, testing for contrasts by the Scheffé's multiple-comparison method [18].…”

“…Patients from this cohort were investigated in our crosssectional study [17]. They were selected from a large data base of patients submitted, for clinical purposes, to an ETT, ABPM and a color Doppler echocardiogram.…”

“…Not all cohort studies, however, have shown that ETT hypertensive response is predictive of hypertension [15], and a consensus International Journal of Cardiology 141 (2010) 243 -249 www.elsevier.com/locate/ijcard statement did not recommend ETT with this objective, mainly because of the absence of a standardized definition of hypertensive response [16]. We reported the influence of the correction of the variation of blood pressure during the ETT by the work performance over the associations of hypertensive response with blood pressure measured by ambulatory blood pressure monitoring (ABPM) and cardiac abnormalities by echocardiogram [17]. Individuals classified at the top tertile of SBP response corrected by the metabolic equivalent task (MET) (≥11.3 mmHg/MET) had higher ABP and a trend for having higher left ventricular septal and posterior wall thickness than individuals classified in the lower tertiles [17].…”

“…We reported the influence of the correction of the variation of blood pressure during the ETT by the work performance over the associations of hypertensive response with blood pressure measured by ambulatory blood pressure monitoring (ABPM) and cardiac abnormalities by echocardiogram [17]. Individuals classified at the top tertile of SBP response corrected by the metabolic equivalent task (MET) (≥11.3 mmHg/MET) had higher ABP and a trend for having higher left ventricular septal and posterior wall thickness than individuals classified in the lower tertiles [17]. These differences were more pronounced than the differences observed between individuals with and without a peak exercise blood pressure higher than 210 mmHg.…”

Richtwerte für Herzfrequenz und Blutdruck bei 20, 40, 60 und 80 % der maximalen ergometrischen Referenzleistung unter Berücksichtigung von Alter, Geschlecht und Körpermasse bei untrainierten Personen

“…Neuere, prospektive Studien assoziierten das Blutdruckverhalten während Belastung mit der Herzfrequenzreserve [16], der metabolischen Einheit (MET) [17], dem Anstieg pro Minute [18], oder mit der Veränderung zum Ruhewert [19] und bestätigen eindrucksvoll, dass das Risiko einer zukünftigen Hypertonie oder eines kardiovaskulären Ereignisses bereits mit leicht main topic erhöhten Belastungswerten signifikant erhöht ist [16,18,20,21]. Ein aktueller Review zum Blutdruckverhalten bei ergometrischen Belastungstests fasst die wichtigsten Ergebnisse zusammen [12].…”