Usefulness of Blood Pressure Rise Prior to Exercise Stress Testing to Predict the Risk of Future Hypertension in Normotensive Korean Men

The aim of this study was to test the hypothesis that blood pressure (BP) increase before exercise stress testing is associated with the incidence of hypertension in a prospective study of 3,805 normotensive men without hypertension at baseline. Changes in BP were defined as the difference between seated BP at rest and BP measured immediately before exercise stress testing. Hypertension was defined as systolic and diastolic BP ≥140/90 mm Hg or hypertension diagnosed by a physician at the second examination. During 18,923 patient-years of follow-up, 371 new cases of hypertension developed (incidence rate 19.6 per 1,000 patient-years). Men with systolic BP changes >0 mm Hg and diastolic BP changes >7 mm Hg had 1.70 times (95% confidence interval [CI] 1.37 to 2.12) and 2.23 times (95% CI 1.76 to 2.82) increased relative risk for incident hypertension compared with men whose systolic BP changes were <0 mm Hg and diastolic BP changes were <7 mm Hg after adjustment for confounders. Men in the highest quartile of mean BP change (>10 mm Hg) had a higher incidence of hypertension (relative risk 2.98, 95% CI 2.19 to 4.06) compared with those in the lowest quartile (<0 mm Hg), and each 1 mm Hg increment in mean BP was associated with a 6% (95% CI 1.05 to 1.09) higher incidence of hypertension after adjustment for risk factors. In conclusion, BP increase before exercise stress testing is associated with incident hypertension, independent of risk factors in normotensive men. The assessment of BP immediately before exercise testing may be a useful addition to the standard exercise stress testing procedures.