REVIEWS   

The Journal of Sports Medicine and Physical Fitness 1998 March;38(1):1-9

Copyright © 1998 EDIZIONI MINERVA MEDICA

language: English

Exaggerated blood pressure response to exercise: pathophysiologic mechanisms and clinical relevance

Palatini P.

Clinica Medica I, University of Padua, Padua, Italy

The assess­ment of ­blood pres­sure ­during ­bicycle ergom­etry or tread­mill exer­cise is con­sid­ered of par­a­mount impor­tance in estab­lishing the eli­gibility of an ath­lete to ­enter com­pet­i­tive ­sports. One of the poten­tial ­risks ­related to an exag­ger­ated ­blood pres­sure ­response to ­stress ­testing is ­that in the ­long run repet­i­tive ­blood pres­sure ­peaks trig­gered by phys­ical ­activity may deter­mine ­chronic ­target ­organ ­damage or ­favour the occur­rence of an ­acute car­di­o­vas­cular ­event. Our con­cern ­should be ­addressed par­tic­u­larly to the com­pet­i­tive ath­lete, ­insofar as ­training ­seems to ­increase the ­blood pres­sure reac­tivity to ­dynamic exer­cise. How­ever, ­studies per­formed in ­young bor­der­line hyper­ten­sive sub­jects ­have dem­on­strated ­that ­blood pres­sure ­level ­during ­steady-­state ­long ­lasting exer­cise can not be pre­dicted by the max­imum ­blood pres­sure ­attained ­during a ­short-­lasting incre­mental ­effort. Sev­eral pros­pec­tive ­studies ­have dem­on­strated ­that exces­sive ­increases in ­blood pres­sure ­during exer­cise may be a ­marker of ­future sus­tained hyper­ten­sion and of ­increased ­risk of car­di­o­vas­cular mor­tality. The ­steeper ­rise in exer­cise ­blood pres­sure in nor­mo­ten­sive sub­jects ­prone to ­develop hyper­ten­sion and its com­pli­ca­tions ­seems to be due to a ­failure to ­reduce ­total periph­eral resis­tance ade­quately ­during exer­cise, as a ­result of ­initial struc­tural vas­cular ­changes ­which ­would pre-­date the ­tonic ele­va­tion in the ­blood pres­sure.