Does exercise-induced hypertension reliably predict established hypertension?

Abstract

Background: Hypertension is a well recognised and modifiable risk factor for cardiovascular disease and stroke, affecting close to 40% of adults globally. Hypertension is usually asymptomatic and early detection allows appropriate management to reduce the associated risks. Blood pressure (BP) increases with physical exertion, and normal values in exercise stress testing (EST) exist. The relationship to established hypertension in patients where BP rise exceeds these values has not been well described. The aim of this retrospective study was to examine the relationship of BP response during EST to hypertension status as defined using the 24 hour average BP from ambulatory blood pressure monitoring (ABPM). Methods: BP data of 723 adult patients (mean age 61 yrs; 415 male) undergoing contemporaneous EST and ABPM were retrospectively analysed. An abnormal EST response was defined as peak systolic BP ≥ 210 mmHg. Established hypertension was defined as ABPM ≥ 130/80 mmHg. EST response was then compared to ABPM. Results: 312 patients had an abnormal BP response during EST and 227 (73%) of these had an abnormal ABPM. 411 patients had a normal BP response during EST and 217 (53%) had a normal ABPM, however 194 (47%) had an abnormal ABPM. Conclusions: While an abnormal BP response during EST often predicts established hypertension (PPV 73%), a normal BP response during EST does not exclude established hypertension (NPV 53%).