Blood Pressure Response to Treadmill Stress TestingInterpretation and Critical Appraisal

A progressive and sustained decrease in systolic blood pressure on the continuation of exercise suggests severe left ventricular dysfunction irrespective of the cause. A transient decrease in systolic blood pressure followed by a normal increase in the continuation of exercise does not have any clinical significance. Failure of systolic blood pressure to increase commensurate to an increase in workload suggests the failure of adequate increase in left ventricular stroke volume with increasing workload. At present there is no consensus about the definition and significance of the exaggerated increase in systolic blood pressure during exercise. This is because different authors have used different criteria for defining abnormal response. An increase in diastolic blood pressure by 10 mm Hg over resting diastolic blood pressure or peak diastolic blood pressure of 110 mm Hg is significant and may be associated with a future risk of hypertension at rest. There is no consensus about the magnitude of the fall in systolic blood pressure during the initial few minutes of recovery. A paradoxical increase rather than a decrease in systolic blood pressure during recovery may be associated with coronary artery disease. Correct auscultatory measurement of blood pressure at peak exercise is difficult. Therefore, some authorities recommend the evaluation of blood pressure at a submaximal workload. This area needs further evaluation.