Exaggerated Blood Pressure Response to Exercise in the Detection of Hypertension

Abstract

Traditionally, screening for the detection of hypertension and the evaluation and monitoring of patients with high blood pressure have been limited to measures recorded with the patient in a resting, sitting position. Ambulatory studies show that blood pressure values vary considerably during the course of daily activities, especially during physical exercise. Thus, measures taken in a resting situation cannot assess the extent of these fluctuations. Recent retrospective studies have revealed that an exaggerated blood pressure response to dynamic exercise in resting normotensive persons may be a valuable indicator of the future development of sustained hypertension. These studies are reviewed with regard to prevalence, sensitivity, specificity, positive and negative predictive values, and relative risk. Age and gender-specific mean blood pressure responses to the Canadian Aerobic Fitness Test (CAFT), a standardized submaximal step-test of aerobic fitness, were used to develop criteria for an exaggerated blood pressure response and to calculate the prevalence of exercise hypertension in Canada using data from the 1981 Canada Fitness Survey. It was estimated that 176,198 Canadians aged 20–69 years who were initially normotensive at rest but who demonstrated an exaggerated blood pressure response to the CAFT, could have now developed sustained hypertension. The utilization and interpretation of an exaggerated blood pressure response to exercise is discussed.