Usefulness of Exercise Stress Testing for Prediction of Blood Pressure Trends

PEDIATRICS ◽  
1985 ◽  
Vol 75 (6) ◽  
pp. 1071-1075
Author(s):  
David E. Fixler ◽  
W. Pennock Laird ◽  
Kent Dana
Keyword(s):  
Blood Pressure ◽  
Stress Testing ◽  
Isometric Exercise ◽  
Systolic Pressure ◽  
Exercise Stress ◽  
Female Adolescents ◽  
Exercise Stress Testing ◽  
Stress Tests ◽  
Blood Pressures

The purpose of this study was to determine whether values of blood pressure during exercise help predict which adolescents are prone to maintain high blood pressure. Dynamic and isometric exercise stress tests were performed on 131 adolescents who had had systolic or diastolic pressures greater than the 95th percentile on three examinations the previous year. Follow-up blood pressures were measured 1 year after the stress testing, and outcomes were classified on the basis of the blood pressure status that year. Stepwise regression analysis was used to examine the association between earlier blood pressures and exercise pressures with outcome pressures. In both male and female adolescents, the average resting systolic pressure on the earlier survey was the best predictor of systolic pressure 2 years later. Blood pressures and heart rates during dynamic and isometric exercise did not significantly contribute to the models' prediction of future systolic or diastolic pressures. The data suggest that exercise stress testing is not a valid method for predicting youths whose blood pressures will remain elevated over the next 1 to 2 years.

Response of Hypertensive Adolescents to Dynamic and Isometric Exercise Stress

PEDIATRICS ◽  
1979 ◽  
Vol 64 (5) ◽  
pp. 579-583
Author(s):  
David E. Fixler ◽  
W. Pennock Laird ◽  
Richard Browne ◽  
Victoria Fitzgerald ◽  
Susan Wilson ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Isometric Exercise ◽  
Systolic Pressure ◽  
Dynamic Exercise ◽  
Exercise Stress ◽  
Stress Tests ◽  
Isometric Handgrip ◽  
Control Subjects ◽  
St Segment ◽  
Blood Pressures

Isometric handgrip and dynamic exercise stress tests were performed on 109 hypertensive and 74 normotensive subjects 14 to 17 years old. The hypertensive subjects had resting systolic or diastolic pressures persistently above the 95th percentile on four consecutive examinations. Blood pressures and ECGs were recorded during isometric handgrip (25% maximum effort for four minutes) and bicycle ergometry until the subject was exhausted. The hypertensive subjects increased systolic pressure by an average 16 mm Hg with isometric exercise and 53 mm Hg with dynamic exercise. Control subjects had similar pressure changes, averaging 18 and 54 mm Hg, respectively. During isometric handgrip stress, diastolic pressures increased 12 mm Hg in hypertensive subjects and 18 mm Hg in control subjects. Only two hypertensive adolescents developed systolic pressures exceeding 220 mm Hg during dynamic exercise stress, and none developed systolic pressures above 200 mm Hg during isometric exercise stress. None of the normotensive or hypertensive subjects developed cardiac arrhythmias and the prevalence of ST segment depression during maximal stress was less than 2% in both groups. Therefore, in adolescents with mild to moderate hypertension the risk of developing significant ECG or hemodynamic abnormalities during mild isometric or heavy dynamic exercise is small. We believe the decision to restrict physical activity of an adolescent with elevated pressures should be based on the development of abnormal ST segment depression, cardiac arrhythmias, or excessive blood pressures at the time of exercise stress testing.

scholarly journals Estimation of the Blood Pressure Response With Exercise Stress Testing

2019 ◽  
Vol 28 (5) ◽  
pp. 742-751 ◽  
Author(s):  
Benjamin T. Fitzgerald ◽  
Emma L. Ballard ◽  
Gregory M. Scalia
Keyword(s):  
Blood Pressure ◽  
Stress Testing ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Exercise Stress ◽  
Exercise Stress Testing

The Clinical Use of Nonimaging Exercise Stress Testing

2019 ◽  
Author(s):  
Aswini Kumar ◽  
Brinda Muthuswamy ◽  
W Lane Duvall ◽  
Paul D Thompson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Testing ◽  
Blood Pressure Response ◽  
Heart Rate Recovery ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Duke Treadmill Score ◽  
Test Exercise ◽  
Artery Disease

Exercise stress testing is an exceptionally useful cardiovascular test providing a wealth of information that can be used in patient management. It can be used in the diagnosis and/or management of chest pain, hypertension, arrhythmia, and heart failure.  Non-imaging exercise stress testing not only helps evaluate the etiology of clinical symptoms but also provides an opportunity to evaluate ECG changes with exercise, total exercise capacity, heart rate response or chronotropic index, blood pressure response, heart rate recovery, and to make estimates of the risk of coronary artery disease using tools such as the Duke Treadmill Score.  These parameters, individually and collectively, provide valuable information on the likelihood of disease and an individual’s prognosis. In addition, exercise testing is inexpensive, quick and widely available compared to imaging studies.  This review contains 6 figures, 5 tables, and 68 references.  Keywords: blood pressure response, chronotropic incompetence, coronary artery disease, Duke Treadmill Score, exercise physiology metabolic equivalents (METs), exercise stress test, exercise treadmill test, exercise-induced hypertension, heart rate recovery, maximal exercise capacity, ST-segment deviation

Prognostic Significance of Systolic Blood Pressure Increases in Men During Exercise Stress Testing

2007 ◽  
Vol 100 (11) ◽  
pp. 1609-1613 ◽  
Author(s):  
Manish Prakash Gupta ◽  
Sotir Polena ◽  
Neil Coplan ◽  
Georgia Panagopoulos ◽  
Charu Dhingra ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Stress Testing ◽  
Prognostic Significance ◽  
Exercise Stress ◽  
Exercise Stress Testing

Evaluating the Situational Specificity of Relaxation in Mild Essential Hypertension

1980 ◽  
Vol 51 (2) ◽  
pp. 667-674
Author(s):  
John E. Martin ◽  
Leonard H. Epstein
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Diastolic Blood Pressure ◽  
Systolic Pressure ◽  
Progressive Relaxation ◽  
Multiple Baseline ◽  
Self Monitoring ◽  
Situational Specificity ◽  
Blood Pressures

A multiple baseline across subject/settings design was employed to assess the specificity of the effects of progressive relaxation in two recently diagnosed, mild hypertensives. Relaxation was implemented successively across laboratory and home settings. In Subject 1, laboratory relaxation was associated with control over diastolic blood pressure, while in Subject 2, control over systolic pressure was observed. Improvements to normotensive levels were observed for both subjects, and the changes were maintained in both settings for Subject 2 at 6- and 12-mo. follow-up. Subject 1 discontinued her medications, relaxation, and self-monitoring of blood pressure, which was associated with an increase in blood pressure during treatment maintenance; however, at 6- and 12-mo. follow-up, both home and laboratory blood pressures were within normotensive range.

scholarly journals Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 435-440 ◽  
Author(s):  
Doug Richards ◽  
Nazanin Meshkat ◽  
Jaqueline Chu ◽  
Kevin Eva ◽  
Andrew Worster
Keyword(s):  
Chest Pain ◽  
Stress Testing ◽  
Stress Test ◽  
Intervention Group ◽  
Exercise Stress Test ◽  
Low Risk ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Control Group

ABSTRACTIntroduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP).Methods:Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations.Results:Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ2= 6.69,p< 0.001) with a relative risk of 1.29 (95% confidence interval 1.18–1.40), and the results remained significant after a “worst case” sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary.Conclusion:When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their FP for further testing in a timely manner as advised. Changing to a strategy of ED booking of exercise stress testing may help earlier identification of patients with coronary heart disease.

Hypertensive response to exercise in adult patients with repaired aortic coarctation

Heart ◽  
2022 ◽  
pp. heartjnl-2021-320333
Author(s):  
Timion A Meijs ◽  
Steven A Muller ◽  
Savine C S Minderhoud ◽  
Robbert J de Winter ◽  
Barbara J M Mulder ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Cardiovascular Events ◽  
Stress Testing ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Male Sex ◽  
Response To Exercise

ObjectiveThe clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive response to exercise, identify factors associated with peak exercise systolic blood pressure (SBP) and explore the association of peak exercise SBP with resting blood pressure and cardiovascular events during follow-up.MethodsFrom the Dutch national CONgenital CORvitia (CONCOR) registry, adults with repaired CoA who underwent exercise stress testing were included. A hypertensive response to exercise was defined as a peak exercise SBP ≥210 mm Hg in men and ≥190 mm Hg in women. Cardiovascular events consisted of coronary artery disease, stroke, aortic complications and cardiovascular death.ResultsOf the original cohort of 920 adults with repaired CoA, 675 patients (median age 24 years (range 16–72 years)) underwent exercise stress testing. Of these, 299 patients (44%) had a hypertensive response to exercise. Mean follow-up duration was 10.1 years. Male sex, absence of a bicuspid aortic valve and elevated resting SBP were independently associated with increased peak exercise SBP. Peak exercise SBP was positively predictive of office SBP (β=0.11, p<0.001) and 24-hour SBP (β=0.05, p=0.03) at follow-up, despite correction for baseline SBP. During follow-up, 100 patients (15%) developed at least 1 cardiovascular event. Peak exercise SBP was not significantly associated with the occurrence of cardiovascular events (HR 0.994 (95% CI 0.987 to 1.001), p=0.11).ConclusionsA hypertensive response to exercise was present in nearly half of the patients in this large, prospective cohort of adults with repaired CoA. Risk factors for increased peak exercise SBP were male sex, absence of a bicuspid aortic valve and elevated resting SBP. Increased peak exercise SBP independently predicted hypertension at follow-up. These results support close follow-up of patients with a hypertensive response to exercise to ensure timely diagnosis and treatment of future hypertension.

Gender differences in exercise stress testing protocol selection, exercise capacity, and prognostic value of METs

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Harb ◽  
T.W Wang ◽  
Y.W Wu ◽  
M.V Menon ◽  
L.C Cho ◽  
...  
Keyword(s):  
Gender Differences ◽  
Exercise Capacity ◽  
Prognostic Value ◽  
Stress Testing ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Metabolic Equivalents ◽  
Testing Protocols ◽  
Gender Specific

Abstract Background Exercise capacity, as measured by metabolic equivalents of task [METs], varies with gender and is an independent predictor of mortality. We sought to investigate gender differences in the protocol selected, the estimated exercise capacity, and the prognostic value of METs. Purpose Investigate the gender differences in the protocol chosen (adjusting for age and comorbidities), the METs achieved (also adjusting for the protocol selected), and the predictive value of exercise capacity adjusted to METs achieved. Methods In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent exercise stress testing. Protocols were split into Bruce vs. non-Bruce. METs were estimated based on established gender-specific formulas (the St James Take Heart Project formula for women, and the Veterans Affairs cohort formula for men).The primary outcome was all-cause mortality. Results The mean age was 53.3±12.5 years, and 59% were male. Table 1 presents the baseline characteristics and exercise parameters. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Females were more commonly referred for non-Bruce protocols [adjusted OR 2.6; 95% CI (2.5–2.7)] even after adjusting for age and comorbidities. Within the same protocol chosen, females achieved lower estimated METs [Beta −1.4; 95% CI (−1.43 to −1.37)]. Exercise capacity was inversely related to mortality in both genders and across protocols (figure 1), however, after adjusting for age, comorbidities, protocol chosen, and the number of METs achieved, the HR for death was significantly lower for women [adjusted HR=0.44; 95% CI (0.41–0.46)]. Conclusion After adjusting for age and comorbidities, women tend to be more commonly referred for non-Bruce protocols, achieve less estimated METs (after adjusting for the protocol chosen), and have half the mortality for the same METs achieved. Death vs. Exercise capacity by gender Funding Acknowledgement Type of funding source: None

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