Does the Dundee Step Test predict outcome in treated hypertension? A sub-study protocol for the ASCOT trial

Treated hypertensive subjects may remain five times more likely to die of c ardiac and cerebrovascular diseases than normotensive subjects with equival ent resting blood pressure (BP) levels. Research evidence suggests that exe rcise BP is a better predictor of endorgan damage and mortality than restin g BP, and data from our centre show that a significant proportion of treate d hypertensives have uncontrolled BP during a 5-min Dundee Step Test, The p rognostic usefulness of exercise BP has yet to be translated into clinical practice because of the lack of a suitable technique. The Dundee Step Test is being evaluated in the ASCOT (Anglo-Scandinavian Cardiac Outcome Trial) study, a 5-year follow-up multicentre, multinational trial comparing the ef fect of newer (amlodipine and perindopril) and older (bendroflumethiazide a nd atenolol) antihypertensive agents stratified according to cholesterol le vels on cardiac outcome. If the value of the Dundee Step Test is proven, th en it may be adopted into routine clinical practice for the assessment of e xercise BP, This may result in the improved management of hypertension with a subsequent reduction in morbidity and mortality, The publication of this study protocol is meant to be a statement of on-going research which may s timulate interest among those with an interest in this area of research.