Exercise Response in Young Women with Borderline Hypertension: MATERIAL AND METHODS

29 Mar

Study Population

One hundred fifty-seven females, mean age 19 ±3 years (range, 16 to 29 years), with BH were referred to us during the period 1965 to 1985. Blood pressure >=140/90 mm Hg was measured on no less than three occasions in each patient prior to referral, and secondary hypertension was excluded. There were no cases of congenital or rheumatic heart disease or cardiomyopathy. There were 98 (62.4 percent) asymptomatic patients, and 59 (37.6 percent) who reported various physical symptoms, the most common being exertional or nonexertional headache, dizziness, fatigue, and palpitations. In addition, 105 healthy, asymptomatic females of similar age, referred within the frame of screening in the general population, not for medical reasons, served as a control group. Mean height was similar in BH patients and controls: 165 ±7 cm and 164 ±5 cm, respectively (NS). However, BH patients were more obese: mean weight was 66.8 ± 15.1 kg and 57.9 ±7.0 kg, respectively (p<0.001). A family history of hypertension was more frequent in BH patients than in the controls: 45.9 percent and 16.8 percent, respectively (p<0.0001). Detailed individual case histories were recorded; each patient underwent a thorough physical examination, resting 12-lead electrocardiography (ECG), and a cycloergometric test.

Exercise Testing

The ergometric test was performed on a mechanically braked bicycle ergometer (Monark), following our previously described protocol. All patients underwent a near-maximal test (85 percent of predicted maximal heart rate according to age) based on progressively increasing intermittent workloads, each of five min­utes’ duration. The initial work load was 50 W. Blood pressure was measured at rest, in the supine and upright positions, at the precise termination of each workload, and during the recovery period. Resting blood pressure levels were measured using a conventional cuffsphygmomanometer. This was carried out in a quiet room, at a comfortable temperature, after the patients had rested for five minutes. They were instructed not to eat or smoke for 30 minutes prior to examination, according to the recommendations of the Special Task Force appointed by the American Heart Association. All patients were informed that the exercise test was a routine procedure. The ECG was monitored continually; heart rate was assessed by means of the ECG tracings.
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Statistical Analysis

All results are expressed as mean±SD. The Students t test was used to examine differences between groups and p values of less than 0.05 were considered significant.