S. Majahalme et al., BLOOD-PRESSURE RESPONSES TO EXERCISE AS PREDICTORS OF BLOOD-PRESSURE LEVEL AFTER 5 YEARS, American journal of hypertension, 10(1), 1997, pp. 106-116
There is considerable disagreement in the literature on the clinical u
sefulness of exercise testing as a tool for prediction of future hyper
tension. Much of the discrepancy between various reports is attributab
le to the difficulties of blood pressure (BP) measurement during exerc
ise. Therefore, we investigated whether accurate intraarterial. BP mea
surement will increase the predictive power of exercise testing. The B
P responses to dynamic and isometric exercise were evaluated in 97 hea
lthy, unmedicated men, of whom 34 were normotensive (NT), 29 borderlin
e (BHT), and 34 mildly hypertensive (HT) using three criteria: 1) achi
eved BP during the test, 2) the change of the BP from baseline to exer
cise, and 3) the group was divided into high responders (HIGH, n = 19,
systolic BP greater than or equal to 220 and diastolic BP greater tha
n or equal to 105 mm Hg) and normal responders (n = 60). Five years la
ter the BP was reassessed by casual measurements and noninvasive ambul
atory 24-h monitoring (NAME) in 79 (81%; 27 NT, 24 BHT, and 28 HT) sub
jects. The achieved isometric BP correlated well with the follow-up BP
(casual systolic BP r = 0.43, diastolic BP r = 0.45, and NAME systoli
c BP r = 0.44, diastolic BP r = 0.58, P < .001). However, achieved dyn
amic BP showed a poorer relationship to future BP (r range, 0.09 to 31
, P = NS to P < .01). Because the intraarterial preexercise sitting BP
also correlated well with follow-up BP (r range, 0.33 to 0.48, P < .0
1 to P < .001), and the r values were close to those of achieved isome
tric BP we used multiple regressions (including all resting and exerci
se BP values as independent variables) to evaluate the contributions o
f the baseline and exercise values for prediction of the follow-up BP.
The baseline value explained 12% to 23% (from casual diastolic BP to
NAME diastolic BP, systolic BP values) of future BP variance, whereas
achieved isometric BP ranged an additional 1% to 11% (from casual syst
olic BP to NAME diastolic BP) of variance. In general, BP change from
baseline with stressors did not correlate with follow-up measurements.
In the high responder group the achieved dynamic BP did not correlate
significantly with the followup BP, whereas the achieved isometric di
astolic BP did correlate (casual diastolic BP r = 0.56, P < .05, NAME
systolic BP and diastolic BP r = 0.52, P <.05). Both groups had simila
r future BP levels. In conclusion, even with very accurate BP readings
the reactivity to dynamic exercise is a weak predictor of future BP,
and does not improve the prediction compared to resting BF values. Int
raarterial BP response to isometric exercise marginally improves the p
rediction of future BP levels. (C) 1997 American Journal of Hypertensi
on, Ltd.