Relationship of Stress Testing Blood Pressure with Electrocardiographic and Fundoscopy Indices of Hypertensive End-Organ Damage

In our study we tested firstly, whether BP changes induced by laboratory stress testing could be better related than resting blood pressure (BP) to hypertensive target-organ damage (TOD) and secondly, whether an exaggerated reactivity to stress testing might be associated with an increased prevalence of TOD. In 49 untreated essential hypertensives, BP measured at sitting rest and during a variety of stressful situations was related to the presence of TOD, assessed by electrocardiography (ECG) and fundoscopy examination. The degree of TOD was significantly correlated to resting SBP; neither SBP at peak of isometric or dynamic exercise, nor SBP during mental test showed a greater correlation with TOD than resting SBP (NS). A large variability of individual's level of BP reactivity across the different laboratory tests was observed. Patients were arbitrarily dichotomised into groups according to a hyperreactive or normoreactive response to each stress testing; patients classified as hyperreactive (SBP increase greater than upper 95% confidence limit) did not disclose a greater rate of cardiac and ocular damage than normoreactors (NS). In conclusion, stress BP does not increase the strength of relationship with TOD compared to resting BP. Cardiovascular reactivity differs according to the laboratory stimulus employed and an exaggerated BP rise during stress testing is not associated with an increased rate of TOD.