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Impaired Exercise Tolerance in Hypertensive Patients

Pitt O. Lim, MBBS, MRCP(UK), DGM; Robert J. MacFadyen, BSc, MD, PhD, MRCP(UK); Peter B.M. Clarkson, MS, ChB, MRCP(UK); and Thomas M. MacDonald, BSc, MD, FRCP(Ed)
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From the University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom. Acknowledgments: The authors thank Mrs. J. Thomson for typing this manuscript. Requests for Reprints: Pitt O. Lim, MBBS, MRCP(UK), University Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, United Kingdom. Current Author Addresses: Drs. Lim, MacFadyen, Clarkson, and MacDonald: University Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, United Kingdom.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_1):41-55. doi:10.7326/0003-4819-124-1_Part_1-199601010-00008
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Purpose: To review information on exercise testing in hypertensive patients and persons at risk for developing hypertension and to determine whether this type of investigation is valuable for diagnosis, prognosis, or assessment of the effect of therapy.

Data Sources: A MEDLINE search of English-language articles published between 1985 and 1995 and reviews of the bibliographies of textbooks.

Study Selection: Primary research articles on exercise testing in patients with hypertension, with an emphasis on methods, diagnosis, prognosis, and assessment of drug therapy.

Data Extraction: Study design and quality were assessed, with particular attention paid to methods and aims. Relevant data on hemodynamic responses in hypertensive patients and persons at risk for developing hypertension and correlations to end-organ damage, mortality, and exercise tolerance were analyzed.

Data Synthesis: The exercise capacity of hypertensive patients was found to be reduced by as much as 30% compared with age-matched controls. This exercise impairment increases with age and end-organ damage, and its origin can be traced back to adolescence. Total peripheral resistance also progressively increases. These changes are caused by functional and structural involvement of the cardiovascular system. Diastolic dysfunction of the heart is a prominent factor in this exercise limitation. The blood pressure responses to exercise have prognostic value for the future development of hypertension, end-organ damage, and death. The adequacy of antihypertensive treatment should therefore be evaluated in terms of normalizing these stress-related blood pressure responses.

Conclusion: Exercise testing is a simple procedure that has great potential for assessing hypertensive patients. More research is necessary, however, to determine whether controlling blood pressure during exercise is beneficial.





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