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ARTICLE |

Treadmill Exercise Testing in Hypertensive Patients Treated With Hydrochlorothiazide and β-Blocking Drugs FREE

Albert J. Miller, MD; Benjamin M. Kaplan, MD; Mark T. Upton, MD; I. Martin Grais, MD; David L. Abrams, MD
[+] Author Affiliations

Reprint requests to Department of Medicine, Northwestern Memorial Hospital, 250 E Superior St, Chicago, IL 60611 (Dr Miller).


JAMA. 1983;250(1):67-70. doi:10.1001/jama.1983.03340010049028
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Twelve patients with hypertension who did not become normotensive after treatment with hydrochlorothiazide alone were studied. Treadmill exercise testing was done before and after additional treatment to standing resting normotension with β-blocker drugs. The double product (peak mean BP times peak heart rate) at peak performance fell significantly because of decreases in systolic arterial BP and heart rate, but diastolic pressures still rose with exercise in ten of the 12 patients, in seven of them to 100 mm Hg or higher. Thus, the data show that patients with hypertension treated to resting normotension with hydrochlorothiazide and a β-blocker still often demonstrate a significant diastolic BP rise with exercise. In such patients, a rise in diastolic BP with exercise cannot be used as evidence of coronary atherosclerosis. The measurement of the arterial BP response to exercise is probably important in the assessment of the effectiveness of individual antihypertensive regimens.

(JAMA 1983;250:67-70)

REFERENCES

Prichard BNC, Gilliam PMS:  Treatment of hypertension with propranolol . Br Med J 1969;; 1:7-16.
Bruce RA:  Exercise testing of patients with coronary artery disease: Principles and normal standards of evaluation . Ann Clin Res 1971;; 3:323-332.
Raine AEG, Pickering TG:  Cardiovascular and sympathetic response to exercise after longterm β-adrenergic blockade . Br Med J 1977;; 2:90-92.
Shinebourne E, Fleming J, Hamer J:  Effects of β-adrenergic blockade during exercise in hypertensive and ischaemic heart disease . Lancet 1967;;2:1217-1220.
Reybrouck T, Amery A, Billiet L:  Hemodynamic response to graded exercise after chronic β-adrenergic blockade . J Appl Physiol 1977;; 42:133-138.
Van Herwaarden CLA, Binkhorst RA, Fennis JFM, et al:  Effects of propranolol and metoprolol on hemodynamic and respiratory indices and on perceived exertion during exercise in hypertensive patients . Br Heart J 1979;;41:99-105.
Lund-Johansen P:  Hemodynamic changes at rest and during exercise in long-term β-blocker therapy of essential hypertension . Acta Med Scand 1974;;195:117-121.
Sheps DS, Ernst JC, Briese FW, et al:  Exercise-induced increase in diastolic pressure: Indicator of severe coronary artery disease . Am J Cardiol 1979;;43:708-712.
Bruce AR, Eleady-Cole R, Bennett LJ, et al:  Divergent effects of antihypertensive therapy on cardiovascular responses and left ventricular function during upright exercise . Am J Cardiol 1972;;30:768-774.
Miller AJ:  The treatment of hypertension . Arch Intern Med 1977;;137:1597-1598.

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Prichard BNC, Gilliam PMS:  Treatment of hypertension with propranolol . Br Med J 1969;; 1:7-16.
Bruce RA:  Exercise testing of patients with coronary artery disease: Principles and normal standards of evaluation . Ann Clin Res 1971;; 3:323-332.
Raine AEG, Pickering TG:  Cardiovascular and sympathetic response to exercise after longterm β-adrenergic blockade . Br Med J 1977;; 2:90-92.
Shinebourne E, Fleming J, Hamer J:  Effects of β-adrenergic blockade during exercise in hypertensive and ischaemic heart disease . Lancet 1967;;2:1217-1220.
Reybrouck T, Amery A, Billiet L:  Hemodynamic response to graded exercise after chronic β-adrenergic blockade . J Appl Physiol 1977;; 42:133-138.
Van Herwaarden CLA, Binkhorst RA, Fennis JFM, et al:  Effects of propranolol and metoprolol on hemodynamic and respiratory indices and on perceived exertion during exercise in hypertensive patients . Br Heart J 1979;;41:99-105.
Lund-Johansen P:  Hemodynamic changes at rest and during exercise in long-term β-blocker therapy of essential hypertension . Acta Med Scand 1974;;195:117-121.
Sheps DS, Ernst JC, Briese FW, et al:  Exercise-induced increase in diastolic pressure: Indicator of severe coronary artery disease . Am J Cardiol 1979;;43:708-712.
Bruce AR, Eleady-Cole R, Bennett LJ, et al:  Divergent effects of antihypertensive therapy on cardiovascular responses and left ventricular function during upright exercise . Am J Cardiol 1972;;30:768-774.
Miller AJ:  The treatment of hypertension . Arch Intern Med 1977;;137:1597-1598.
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