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.