IS INAPPROPRIATE HYPERTENSIVE RESPONSE TO EXERCISE TEST USEFUL TO SCREEN FOR HYPERTENSION IN COPD PATIENTS?

Abstract

We have previously shown that the increase in systolic blood pressure (SBP) during exercise test is much steeper in patients with chronic obstructive pulmonary disease (COPD) compared to healthy individuals matched for age. Inappropriate hypertensive response to maximal exercise (≥ 220/100 mmHg) has been associated with future development of hypertension. In the settings of a rehabilitation respiratory exercise program evaluation, exercise physiologist are often confronted with inappropriate high blood pressure (BP) response during exercise testing. PURPOSE We sought to evaluate if inappropriate hypertensive response to maximal exercise test is a reliable parameter as a screening tool for hypertension compared to office and 24-hr ambulatory BP. METHODS Twenty-three COPD patients (age: 65±7 years [mean±SD], FEVI: 40±15% predicted) performed a peak ergocycle exercise test and a 24-hr ambulatory BP monitoring. Resting BP was measured after a 15-minute resting period in supine position and maximal exercise BP was measured at the end of the peak exercise test. RESULTS Mean resting, exercise and 24-hr BP was respectively 145/73±16/11 mmHg, 231/102±24/17 mmHg and 129/75±10/8 mmHg. Sixty-one percent and 30% of patients with inappropriate hypertensive response to maximal exercise showed high BP on resting and 24-hr respectively. The association between exercise SBP and resting SBP was the following; r = 0.65, p < 0.01 but there is no relationship between exercise SBP and 24-hr SBP monitoring (r = 0.28, p = 0.19). CONCLUSION Thus, maximal exercise SBP may be a reliable index to predict office hypertension but not 24-hr high BP in patients with COPD. Supported in part by Le Fond de Recherche en Santé du Québec.