A group of 157 young women with BH was found to have higher levels of systolic and diastolic blood pressure at all stages of dynamic exercise compared with values in normotensive controls. However, the systolic and diastolic blood pressure changes in the BH patients resembled the normal response found in the controls. The data on exercise testing in young women with high resting blood pressure are limited: most studies describe children or adolescents, either males only or mixed groups of boys and girls. Hansen et al found that blood pressure change during exercise did not differ in normotensive girls compared with hypertensive girls. Other studies of blood pres­sure response to exercise in young populations of both sexes did not reveal a uniform pattern of blood pressure change. This variation in results may be attributed to several factors, such as personal characteristics or the definition of hypertension. Sex variabilities in blood pressure values, both at rest and on effort, probably also play an important role. Normotensive women had lower blood pressure on ambulatory measurement using an automatic device; normoten­sive and hypertensive women showed a lower increase in blood pressure and heart rate during isometric exercise. These differences were attributed to envi­ronmental, hormonal, or behavioral parameters, and it is accepted that sympathetic activity is a major element in determining blood pressure levels. Hyper­tensive women were found to have lower catechola­mine levels than men and to have a smaller increase of catecholamines during mental stress, head-up tilt, and isometric exercise. Whether this response to various stimuli is related to different modes of secre­tion of catecholamines or to different clearance rates of catecholamines remains to be clarified. Another frequently mentioned factor is the inotropic action of estrogens that may play a role in the varying blood pressure response of females compared with males. It has recently been suggested that exercise blood pres­sure might be more accurate as a predictor of hyper­tension than resting blood pressure, and may also serve in identifying subjects with sustained hyperten­sion that will, in all probability, have developed by long-term follow-up.

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Near-Maximal Physical Working Capacity (PWC_l70) Mean PWC₁₇₀ in BH patients was significantly lower than in the controls: 71 ± 23 W and 90 ± 17 W, respec­tively (p<0.001). Mean PWC₁₇₀ did not differ signifi­cantly between symptomatic and asymptomatic BH patients: 72 ± 24 W and 69 ± 20 W, respectively.

Heart Rate and Blood Pressure

Mean heart rate, systolic and diastolic blood pres­sure, and pulse pressure levels at both rest and exercise were significantly higher in BH patients compared with the controls (Fig 1). Systolic blood pressure of >200 mm Hg at near-maximal exercise was found in 17 (10.8 percent) BH patients, but this level was not demonstrated among the controls (p<0.001). A raised diastolic blood pressure of ^90 mm Hg at near- maximal exercise was observed in 28 (17.8 percent) BH patients but not among the controls (p<0.001). A decrease in systolic blood pressure at near-maximal load below the resting value, or of not less than 10 mm Hg compared with the former workload, was observed in six (3.8 percent) BH patients, but it was not demonstrated among the controls (NS).

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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.

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Elevated blood pressure is well recognized as a  major risk factor for cardiovascular disease. Early detection of hypertension and appropriate ther­apy have been proven beneficial for the patients prognosis. Some young individuals with initially raised blood pressure levels will, presumably, be at risk for subsequent hypertension. Several studies have demonstrated a correlation between blood pressure levels in young persons and values recorded for these subjects 20 or 30 years later. However, it is difficult to establish an accurate definition of hypertension in the younger population, and this has promoted inter­est in exercise as a complementary test in the routine workup and diagnosis of borderline hypertension (BH). The stress of exercise may in itself serve as a means by which the effect of anxiety—a potential cause of elevated blood pressure levels in normoten- sive persons—can be reduced. On the other hand, normotensives with unusually high blood pressure response during physical activity are at increased risk for future development of cardiovascular complica­tions. Read the rest of this entry »