BLOOD-PRESSURE MEASUREMENT DURING ERGOMETRIC STRESS-TESTING

Evaluation of high-blood pressure would be greatly facilitated by a st andardized test procedure that could enable comparable and reproducibl e blood pressure determinations to be made. It would also be useful to have a standardized method for monitoring sympathetic activity, so th at the occurrence and magnitude of inordinate stress responses could b e assessed more accurately. One way to meet these requirements is thro ugh standardized ergometric testing at workloads of 50 to 100 watts us ing 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 mor e 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 minu te. There are several studies showing that the blood pressure response to ergometry predicts future hypertension in patients with normal res ting blood pressure. Patients suffering from mild hypertension showed significantly (p < 0.001) higher blood pressures (213 +/- 22/116 +/- 1 1 mm Hg) at 100 W and after exercise than age-matched normotensives (1 88 +/- 14/92 +/- 9 mm Hg) but significantly (p < 0.001) lower values t han hypertensives with stable hypertension (225 +/- 22/126 +/- 11 mm H g). 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 hypertens ives. Follow-up examinations several years (average 3.8 years) later s ubsequently showed that 97 % of the ergometric-positive borderline hyp ertensives developed established hypertension. Ergometric studies also assume a prognostic importance, with respect to prevention of acute a nd chronic complications of hypertension. Therefore, we must require t hat antihypertensive drugs not only normalize the resting blood pressu re, but also lower the blood pressure adequately in stressful situatio ns. This requirement is by no means satisfied by all hypertensive drug s that are effective at rest.