Exercise hypertension: historical, physiologic and clinical aspects of ergometry
Hollmann, W.
Herz 12(2): 83-98
1987
ISSN/ISBN: 0340-9937 PMID: 3556364 Document Number: 288657
More than a decade before Riva Rocci in 1896 described the principles of blood pressure measurement as still employed today, in 1881 Zadek reported that there is an increase in blood pressure during physical work. The blood pressure increase during physical exercise as well as its extent as a relatively constant physiological response to a given workload were delineated accurately for the first time, however, in the 1950s. There is no significant difference between the blood pressure increase seen in conditioned athletes and untrained individuals at comparable workloads. In healthy male subjects, a comparison was carried out of the reactions of cardiopulmonary and metabolic parameters during five different modes of exercise. The highest values for oxygen uptake as well as the highest heart rates can be observed during treadmill ergometry; with this method, the largest muscle mass is activated. During both treadmill ergometry as well as during step climbing, the blood pressure can be measured only invasively. As compared with bicycle ergometry in the seated position, the stroke volume increase is only relatively small during supine pedaling. Accordingly, to reproduce situations similar to that of everyday activity exercise testing should be carried out in an upright position. Vascular and cardiac catheterization, however, can be performed more easily in the supine than in the seated position. With these facts in mind, the appropriate methods should be chosen according to the needs of the study and the condition of the patient. During continuously increasing workloads, the systolic pressure increases proportionately. Immediately after termination of exercise, this pressure decreases rapidly over two to three minutes. The diastolic pressure measured noninvasively during seated bicycle ergometry is not particularly accurate and should be interpreted with caution. In general, exercise blood pressure should be determined during a standardized test beginning with a workload of 30 watts for three minutes and subsequent workloads incremented 40 watts for three minutes each. The normal ranges for younger and older patients differ substantially. Additionally, body weight exerts an influence on exercise blood pressure. During exercise, patients with hypertension may show one of three different reactions: the increased pressure can be maintained relative to the normal values during the specified workloads, the blood pressure can show normalization and the systolic blood pressure can remain constant or even decrease at higher workloads.