Dundee step test: a simple method of measuring the blood pressure responseto exercise

The exercise systolic blood pressure (BP) response provides prognostic info rmation over and above that of resting clinic BP in both normotensive and h ypertensive individuals. We have developed a 3-min step test as a method of measuring the exercise systolic BP. Healthy volunteers and patients referr ed for assessment of hypertension took part in validating this exercise tes t. We assessed the reproducibility of the exercise systolic BP response, an d this was compared with that obtained using the cycle ergometry at an equi valent workload. We also compared the baseline characteristics, BP profiles and exercise systolic BP responses in different subject groups. The intra- observer coefficient of variation assessed in 25 subjects was 5.9% with a m ean difference of 1.8 mm Hg, The values for between observer were 8.3% and 2.5 mm Hg respectively. Exercise systolic BP measured with the step test co rrelated with that of cycle ergometer (n = 37, r = 0.93, P < 0.01). Exercis e systolic BP data from healthy volunteers (n = 107) showed a normal distri bution. An exercise systolic BP of greater than or equal to 180 mm Hg was g reater than 2 standard deviations from the mean and was taken as an abnorma lly high BP during exercise. There was a positive correlation between exerc ise BP and increasing age in healthy volunteers (r = 0.57, P < 0.01). This was also present in hypertensive subjects (n = 46, r = 0.48, P = 0.001), ho wever the slope of this relationship was twice as steep as in the normal su bjects. Hypertensive subjects with high exercise systolic BP had significan tly higher clinic BP, ABPM and a greater BP rise during exercise. The Dunde e step test is quick, reproducible and may be prognostically useful.