Sports Medicine

, Volume 5, Issue 6, pp 353–374

Blood Pressure Behaviour During Physical Activity

  • Paolo Palatini
Review Article

Summary

Aerobic exercise is currently being recommended in addition to pharmacological therapy for lowering blood pressure levels in hypertensive patients, i.e. in subjects whose resting blood pressure levels exceed 145/90mm Hg. On the other hand competitive sports are generally contraindicated in hypertensives, who are thought to be at increased risk of morbidity or mortality from their blood pressure levels. The present knowledge of blood pressure behaviour during isotonic physical activity is almost wholly based on the results obtained by means of the ergometric tests. Several maximal and submaximal exercise protocols have been introduced, but none has proved to be superior for diagnostic purposes. There is general agreement that the systolic blood pressure increase determined by isotonic exercise usually ranges from 50 to 70mm Hg in both normotensive or hypertensive subjects. Diastolic blood pressure shows only minor changes in the normotensives, while in the hypertensives it tends to substantially increase because of their inability to adequately reduce their peripheral resistance. This mechanism may also explain the delay shown by the hypertensives in reaching pre-exercise blood pressure values during the recovery. On average diastolic blood pressure increases to a greater extent during bicycle ergometry than during treadmill, while no differences in exertional systolic blood pressure have been observed between the 2 tests. The results of several studies indicate that the blood pressure response to isotonic exercise is a marker for detection of hypertension earlier in the course of the disease, while resting blood pressure is still normal. According to some authors it is also of value in predicting future hypertension in individuals with borderline pressure levels. There are no conclusive data on the effect of training on blood pressure response to exercise. The majority of the published studies report small exertional pressure reductions after conditioning, which would merely reflect the reduction in resting blood pressure. Vasodilatation greatly influences the exercise-induced rise in blood pressure; in fact the exertional pressor increase is blunted when the test is preceded by an adequate warm-up session. Isometric effort is thought to be contraindicated in hypertensive subjects, as it causes a pronounced increase not only of systolic but also of diastolic pressure. Mean blood pressure is, however, increased to the same extent by isotonic and isometric exercise, even though minor discrepancies have been reported by some authors.

The purpose of exercise testing in sports medicine is to assess the athlete’s blood pressure under conditions which are like those which occur in athletics. Unfortunately stress tests are not the same as competitive athletics, so that a direct comparison cannot be made. Recently an intra-arterial technique suitable for studying blood pressure changes in ambulatory subjects has been developed. This method shows that the pressure response to different isotonic activities varies in relation to the sport performed; mean blood pressure does not increase and even lowers during track running, while it greatly exceeds pre-exercise levels during outdoor cycling.

Weight lifting produces sharp elevations of both systolic and diastolic blood pressure, lending further support to the current belief that isometric sports are contraindicated in hypertension. The results of intra-arterial recordings indicate that stress testing to ascertain the athlete’s blood pressure response to exercise should be tailored according to the specific sport one practises.

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References

  1. Aspromonte N, Zeppilli P. Protocollo per la standardizzazione della prova da sforzo con step test di Montoye. Med Spor 38: 419–424, 1985Google Scholar
  2. Astrand PO, Rodahl K. Textbook of work physiology, McGraw-Hill Book Company Inc., New York, 1970Google Scholar
  3. Bachmann K, Zerzawy R, Riess PJ, Zolch KA. Blutdrucktele-metrie: kontinuerliche, direkte blutdruckmessungen im Altag umnd beim sport. Deutsche Medizinish Wochenschrift, 14:741–747, 1970CrossRefGoogle Scholar
  4. Balke B, Ware R. An experimental study of physical fitness of air force personnel. U.S. Armed Force Medical Journal 10: 675–688,1959Google Scholar
  5. Bezucha GR, Lenser MC, Hanson PG, et al. Comparison of hemodynamic responses to static and dynamic exercise. Journal of Applied Physiology 53: 1589–1592, 1982PubMedGoogle Scholar
  6. Boyer JL, Kasch FW. Exercise therapy in hypertensive men. Journal of the American Medical Association 211: 1668–1671, 1970PubMedCrossRefGoogle Scholar
  7. Brooks GA, Hittleman KJ, Beyer RE. Temperature, skeletal muscle, mitocondrial functions, and oxygen debt. Physiologist 13: 156–162, 1970Google Scholar
  8. Brorson L, Wasir H, Sannerstedt R. Haemodynamic effects of static and dynamic exercise in males with arterial hypertension of varying severity. Caridovascular Research 12: 269–275, 1978CrossRefGoogle Scholar
  9. Bruce RA. Exercise testing of patients with coronary heart disease: principles and normal standards for evaluation. Annals of Clinical Research 3: 323–332, 1971PubMedGoogle Scholar
  10. Bruce RA, Gey Jr, GO, Cooper MN, Fisher LD, Peterson DR. Seattle heart watch: initial clinical circulatory and electrocardiographic responses to maximal exercise. American Heart Journal 33: 459–469, 1974aGoogle Scholar
  11. Bruce RA, Fisher LD, Cooper MN, Gey Go. Separation of effects of cardiovascular disease and age on ventricular function with maximal exercise. American Heart Journal 34: 757–763,1974bGoogle Scholar
  12. Burns DM, MacDonald SG. Beats. In Burns & MacDonald (Eds) Physics for biology and premedical students, p. 244, London, 1970Google Scholar
  13. Cantor A, Gold B, Gueron M, Cristal N, Prajgrod G, et al. Isotonic and isometric effort in the assessment and evaluation of diastolic hypertension: correlation and clinical use. Cardiology 74: 141–146, 1987PubMedCrossRefGoogle Scholar
  14. Chaney RH, Arndt S. Predictability of blood pressure response to isometric stress. American Journal of Cardiology 51: 787–790, 1983PubMedCrossRefGoogle Scholar
  15. Choquette G, Ferguson RJ. Blood pressure reduction in borderline hypertensives following physical training. Canadian Medical Association Journal 108: 699–703, 1973PubMedGoogle Scholar
  16. Clausen JP. Circulatory adjustments to dynamic exercise and effects of physical training in normal subjects and in patients with coronary artery disease. In Sonnenblick & Lesch (Eds) Exercise and heart disease, pp. 39–75, Grune and Stratton, New York, 1977Google Scholar
  17. Clausen JP, Trap-Jensen J. Heart rate and arterial blood pressure during exercise in patients with angina pectoris. Circulation 53: 436–442, 1976PubMedCrossRefGoogle Scholar
  18. Cody RJ, Kubo SH, Covit AB, Muller FB, Lopez-Ovejero J, et al. Exercise hemodynamics and oxygen delivery in human hypertension. Hypertension 8: 3–10, 1986PubMedCrossRefGoogle Scholar
  19. Cohess KA, Fenster PE. Clinical implications of the blood pressure response to exercise. Cardiology 68: 233–244, 1981CrossRefGoogle Scholar
  20. Crawford MH, White DH, Amon KW. Echocardiographic evaluation of left ventricular size and performance during handgrip supine and upright bicycle exercise. Circulation 59: 1188–1196, 1979PubMedCrossRefGoogle Scholar
  21. Criqui MH, Haskell WL, Heiss G, Tyroler HA, Green P, et al. Predictors of systolic blood pressure response to treadmill exercise: the lipid research clinics program prevalence study. Circulation 68: 225–233, 1983PubMedCrossRefGoogle Scholar
  22. Dal Monte A. Physiological classification of sports activities and cardiovascular function. International Conference on Sports Cardiology, Rome, April 1978, pp. 161–199, Gaggi, Bologna, 1980Google Scholar
  23. Dal Monte A, Faccini P, Biffi A, Faina M. The specific ergometry in the maximum stimulation of cardiac activity. New Trends in Arrhythmias 4: 613–618, 1988Google Scholar
  24. Daniels J, Foster C, Daniels S, Krahenbuhl GS. Altitude and human performance, with special consideration of the aerobic demands of running. Proceedings of the NCPEAM/NAPECW National Conference, Orlando, pp 61–67, 1977Google Scholar
  25. De Plaen JF, Detry JM. Hemodynamic effects of physical training in established arterial hypertension. Acta Cardiologica 35: 179–188, 1980PubMedGoogle Scholar
  26. Dlin RA, Hanne N, Silverberg DS, Bar-Or O. Follow-up of normotensive men with exaggerated blood pressure response to exercise. American Heart Journal 106: 316–320, 1983PubMedCrossRefGoogle Scholar
  27. Editorial. Let me carry your suitcase. Lancet 2: 754–755, 1975Google Scholar
  28. Ellestad MH, Allen W, Wan MCK, Kemp G. Maximal treadmill stress testing for cardiovascular evaluation. Circulation 39: 517–522, 1969PubMedCrossRefGoogle Scholar
  29. Ewing DJ, Kerr F, Legget R, Murray A. Interaction between cardiovascular responses to sustained handgrip in patients with hypertension. British Heart Journal 38: 483–490, 1976PubMedCrossRefGoogle Scholar
  30. Fagard R, Aubert A, Staessen J, Vandenejnde E, Vanhess L, et al. Cardiac structure and function in cyclists and runners. Comparative echocardiographic study. British Heart Journal 52: 124–129, 1984PubMedCrossRefGoogle Scholar
  31. Falkner B, Kushner H, Onesti G, Angelakos ET. Cardiovascular characteristics in adolescents who develop essential hypertension. Hypertension 3: 521–527, 1981PubMedCrossRefGoogle Scholar
  32. Fisher ML, Nutter DO, Giacob W, Schlant RC. Hemodynamic responses to isometric exercise (handgrip) in patients with heart disease. British Heart Journal 35: 422–432, 1973PubMedCrossRefGoogle Scholar
  33. Fixler DE, Laird WP, Browne R, Fitzgerald V, Wilson S, et al. Response of hypertensive adolescents to dynamic and isometric exercise stress. Pediatrics 64: 579–583, 1979PubMedGoogle Scholar
  34. Fleck SJ, Dean LS. Resistance training experience and the pressor response during resistance exercise. Journal of Applied Physiology 63: 116–120, 1987PubMedGoogle Scholar
  35. Floras JS, Hassan MO, Gever PS, Jones JV, Osikowska B, et al. Cuff and ambulatory blood pressure in subjects with essential hypertension. Lancet 2: 107, 1981PubMedCrossRefGoogle Scholar
  36. Folli G, Radice M, Castelli MR, et al. Expression of results of exercise test in supine position: nomograms according to age and sex. In Rulli et al. (Eds) Normal values in adults ergometry according to age, sex and training, pp. 59–66, Minerva Medica Torino, 1983Google Scholar
  37. Franz IW. Differential antihypertensive effect of acebutolol and hydroclorothiazide/amiloride hydrocloride combination on elevated exercise blood pressures in hypertensive patients. American Journal of Cardiology 46: 301–306, 1980PubMedCrossRefGoogle Scholar
  38. Franz IW. Assessment of blood pressure response during ergometric work in normotensive and hypertensive patients. Acta Medica Scandinavica 670 (Suppl.): 35–47, 1982bPubMedGoogle Scholar
  39. Franz IW. Ergometry in the assessment of arterial hypertension. Cardiology 72: 147–159, 1985PubMedCrossRefGoogle Scholar
  40. Franz IW, Bartels F, Muller R. Blood-pressure response to ergometric work in normotensive subjects, aged 20–50 years. Zeitschrift fur Kardiologie 71: 458–465,1982PubMedGoogle Scholar
  41. Gordon NF, Van Reusburg JP, Van Den Hever DP, Kalliatakis NB, Myburgh DP. Effect of dual β-blockade and calcium antagonism on endurance performance. Medicine and Science in Sports and Exercise 19: 1–6, 1987PubMedGoogle Scholar
  42. Gould BA, Hornung RS, Altman DG, Cashman PM, Raftery EB. Indirect measurement of blood pressure during exercise testing can be misleading. British Heart Journal 53: 611–615, 1985PubMedCrossRefGoogle Scholar
  43. Grossman W, McLaurin LPP, Saltz SB, Paraskos JA, Dalen JE, et al. Changes in the inotropic state on the left ventricle during isometric exercise. British Heart Journal 35: 697–704, 1973PubMedCrossRefGoogle Scholar
  44. Hagberg JM, Goldring D, Ehsani AA, et al. Effect of exercise training on the blood pressure and haemodynamics of adolescent hypertensives. American Journal of Cardiology 52: 763–768, 1983PubMedCrossRefGoogle Scholar
  45. Hall-Yurkowski J, Sutton JR, Duke RJ. Subarachnoid hemorrhage in association with weight lifting. Abstract. Canadian Journal of Applied Sport Science 8: 210, 1983Google Scholar
  46. Hanson JS, Nedde WH. Preliminary observation on physical training for hypertensive males. Circulation Research 27 (Suppl. 1): 49–53, 1970PubMedGoogle Scholar
  47. Helfant RH, deVilla MA, Meister SG. Effect of sustained isometric handgrip exercise on left ventricular performance. Circulation 44: 982–993, 1971PubMedCrossRefGoogle Scholar
  48. Hellerstein HK, Franklin BA. Evaluating the cardiac patient for exercise therapy: role of exercise testing. Clinics in Sports Medicine 3 (2): 371–393, 1984PubMedGoogle Scholar
  49. Herrick JF, Grindlay JH, Baldes EJ, Mann FC. Effect of exercise on the blood flow in the superior mesenteric, renal and common iliac arteries. American Journal of Physiology 128: 338–343, 1939Google Scholar
  50. Heyeden S, Bartel AG, Hames CG, McDonough JR. Elevated blood pressure levels in adoloscents: Evans county, Georgia. Journal of the American Medical Association 209: 1683–1689, 1969CrossRefGoogle Scholar
  51. Hoel BL, Lorentsen E, Lund-Larsen PG. Haemodynamic responses to sustained hand-grip in patients with hypertension. Acta Medica Scandinavica 188: 491–495, 1970PubMedCrossRefGoogle Scholar
  52. Irving IB, Bruce RA, DeRouen TA. Variations in the significance of systolic pressure during maximal exercise (treadmill) testing. American Journal of Cardiology 39: 841–848, 1977PubMedCrossRefGoogle Scholar
  53. Johnson WP, Grover JA. Haemodynamic and metabolic effects of physical training in four patients with essential hypertension. Canadian Medical Association Journal 96: 842–846, 1967PubMedGoogle Scholar
  54. Jones RI, Lahiri A, Cashman PMM, Dore C, Raftery EB. Left ventricular function during isometric hand grip and cold stress in normal subjects. British Heart Journal 55: 246–252, 1986PubMedCrossRefGoogle Scholar
  55. Julius S, Schork MA. Predictors of hypertension. Annals of the New York Academy of Sciences 304: 38–52, 1978PubMedCrossRefGoogle Scholar
  56. Kaufman FL, Hughson RL, Schaman JP. Effect of exercise on recovery blood pressure in hypertensive and normotensive subjects. Medicine and Science in Sports and Exercise 19: 17–20, 1987PubMedCrossRefGoogle Scholar
  57. Kino M, Lance VQ, Shahamatpour A, Spodick DH. Effects of age in response to isometric exercise. American Heart Journal 90: 575–581, 1975PubMedCrossRefGoogle Scholar
  58. Klein AA, McCrory WW, Engle MA, Rosenthal R, Ehlers KH. Sympathetic nervous system and exercise tolerance response in normotensive and hypertensive adolescents. Journal of the American College of Cardiology 3: 381–386, 1984PubMedCrossRefGoogle Scholar
  59. Koch G. Haemodynamic adaptation at rest and during exercise to long-term antihypertensive treatment with combined alpha- and beta-adrenoreceptor blockade by labetalol. British Heart Journal 41: 192–198, 1979PubMedCrossRefGoogle Scholar
  60. Krayenbuhel HP, Rutishauser W. Haemodynamic consequences and clinical significance of the handgrip test. European Journal of Cardiology 1: 5–9, 1973Google Scholar
  61. Krotkiewski M, Mandroukas M, Sjostrom L, Sullivan L, Wetterquist K, et al. Effects of long-term physical training on body fat, metabolism and blood pressure in obesity. Metabolism 28: 650–658, 1979PubMedCrossRefGoogle Scholar
  62. Laird WP, Fixler DE, Huffines FD. Cardiovascular response to isometric exercise in normal adolescents. Circulation 59: 651–654, 1979PubMedCrossRefGoogle Scholar
  63. Lake BJ. Arterial pressures and dynamic exercise. Colloquium at the University of New England, Armidale, 1982Google Scholar
  64. Lamid S, Wolff FW. Drug failure in reducing pressor effect of isometric handgrip stress test in hypertension. American Heart Journal 86: 211–215, 1973PubMedCrossRefGoogle Scholar
  65. Leibel B, Kobrin I, Ben-Ishay D. Exercise testing in assessment of hypertension. British Medical Journal 285: 1535–1536, 1982PubMedCrossRefGoogle Scholar
  66. Levy AM, Tabakin BS, Hanson JS. Hemodynamic responses to graded treadmill exercise in young untreated labile hypertensive patient. Circulation 35: 1063–1072, 1967PubMedCrossRefGoogle Scholar
  67. Lind AR, McNicol GW, Donald KW. Circulatory adjustments to sustained (static) muscular activity. In Evang & Andersen (Eds) Proceedings of the Symposium on Physical Activity in Health and Disease, pp. 36–63, Universitatsforlaget Oslo, 1966Google Scholar
  68. Lind AR, McNicol GW. Muscular factors which determine the cardiovascular responses to sustained and rhythmic exercise. Canadian Medical Association Journal 96: 706–715, 1967PubMedGoogle Scholar
  69. Ludbrook J. Reflex control of blood pressure during exercise. Annual Reviews in Physiology 45: 155–168, 1983CrossRefGoogle Scholar
  70. Lund-Johansen P. Hemodynamics in essential hypertension. Acta Medica Scandinavica (Suppl. 482): 1, 1967Google Scholar
  71. Lund-Johansen P. Hemodynamic changes at rest and during exercise in long-term beta-blocker therapy of essential hypertension. Acta Medica Scandinavica (195): 117–121, 1974PubMedCrossRefGoogle Scholar
  72. Lund-Johansen P. Hemodynamic consequences of long-term beta-blocker therapy: a 5 year follow-up study of atenolol. Journal of Cardiovascular Pharmacology 1: 487–495, 1979PubMedCrossRefGoogle Scholar
  73. Macdonald HR, Sapru RP, Taylor SH, Donald KW. Effect of intravenous propranolol on the systemic circulatory response to sustained handgrip. American Journal of Cardiology 18: 333–344, 1966PubMedCrossRefGoogle Scholar
  74. MacDougall JD, Reddan WG, Layton CR, Dempsey JA. Effects of metabolic hyperthermia on performance during heavy prolonged exercise. Journal of Applied Physiology 36: 538–544, 1974PubMedGoogle Scholar
  75. MacDougall JD, Tuxen D, Sale G, Moroz JR, Sutton JR. Arterial blood pressure response to heavy resistance exercise. Journal of Applied Physiology 58: 785–790, 1985PubMedGoogle Scholar
  76. Maksud MG, Coutts KD, Hamilton LH. Time course of heart rate, ventilation, and V̇2: during laboratory and field exercise. Journal of Applied Physiology 30: 536–539, 1971PubMedGoogle Scholar
  77. Mancia G, Bertini G, Grassi G, Parati G, Pomidossi G, et al. Effects of blood pressure measurement by the doctor on patient’s blood pressure and heart rate. Lancet 2: 695–704, 1983PubMedCrossRefGoogle Scholar
  78. Manon BJ. Structural features of the athlete heart as defined by echocardiography. American Journal of Cardiology 7: 190–203, 1986CrossRefGoogle Scholar
  79. Matthes D, Schutz P, Hullemann KD. Unterschiede zwieschen indirekt und direkt ermittelten Blutdruckwerten. Medizinische Klinik 11: 371–378, 1978Google Scholar
  80. McCloskey DI, Streatfield KA. Muscular reflex stimuli to the cardiovascular system during isometric contractions of muscle groups of different mass. Journal of Physiology (London) 250: 431–441, 1975Google Scholar
  81. Mitchell JH, Wildenthal K. Static (isometric) exercise and the heart; physiological and clinical considerations. Annual Review of Medicine 25: 369–381, 1974PubMedCrossRefGoogle Scholar
  82. Mitchell JH, Reardon WC, McLosky I. Reflex effects on circulation and respiration from contracting skeletal muscle. American Journal of Physiology 233: H374–H378, 1977PubMedGoogle Scholar
  83. Mitchell JH, Payne FC, Saltin B, Schibye B. The role of muscle mass in the cardiovascular response to static contractions. Journal of Physiology (London) 209: 45–54, 1980Google Scholar
  84. Mormino P, Palatini P, Di Marco A, Sperti G, Cordone L, et al. Computer analysis of continuous direct blood pressure recording. Clinical and Experimental Hypertension A7: 455–461, 1985CrossRefGoogle Scholar
  85. Morris JN, Chace SPW, Adam C, et al. Vigorous exercise in leisure-time and the incidence of coronary heart disease. Lancet 1: 333–339, 1973PubMedCrossRefGoogle Scholar
  86. Palatini P. II test da sforzo dinamico nella valutazione del paziente iperteso. L’informazione Cardiologica 4: 13–15, 1986aGoogle Scholar
  87. Palatini P, Di Marco A, Mormino P, Sperti G, Cordone L. Computer analysis of the Oxford continuous blood pressure monitoring: data processing system. Proceedings of the International Telemetering Conference, Las Vegas, October 22–25, 1984. pp. 805–808, 1984Google Scholar
  88. Palatini P, Libardoni M, Bastanzetti M, Solda G, Dal Paid C. Effetto deirallenamento alPesercizio fisico sulla pressione arteriosa in soggetti normotesi. Proceedings of the conference on sport cardiology, Venezia, in press, 1984Google Scholar
  89. Palatini P, Maraglino G, Mos L, Munari L, Ronsisvalle G, et al. Effect of endurance training on QT interval and cardiac electrical stability in boys aged 10 to 14. Cardiology 74: 400–407, 1987ePubMedCrossRefGoogle Scholar
  90. Palatini P, Maraglino G, Sperti G, Calzavara A, Libardoni M, et al. Prevalence and possible mechanisms of ventricular arrhythmias in athletes. American Heart Journal 110: 560–567, 1985aPubMedCrossRefGoogle Scholar
  91. Palatini P, Mormino P, Di Marco A, Libardoni M, Mos L, et al. Ambulatory blood pressure versus casual pressure for the evaluation of the target organ damage in hypertension: complications of hypertension. Journal of Hypertension 3: 425–427, 1985cCrossRefGoogle Scholar
  92. Palatini P, Mos L, Di Marco A, Mormino P, Munari L, et al. Intraarterial blood pressure recording during sport activities. Journal of Hypertension 5 (Suppl. 5): 1987cGoogle Scholar
  93. Palatini P, Mos L, Di Marco A, Mormino P, Munari L, et al. Intraarterial blood pressure during running in man: the beat phenomenon. Giornale Italiano di Cardiologia 17: 680–689, 1987dPubMedGoogle Scholar
  94. Palatini P, Mos L, Mormino P, Di Marco A, Munari L, et al. Blood pressure variability in athletics. Proceedings of the international workshop on indirect blood pressure monitoring, Berlin, May 8th–10th, 1987bGoogle Scholar
  95. Palatini P, Mos L, Munari L, Dal Palu C. Intraarterial blood pressure recording during sports activities. Proceedings of the 2nd International Conference on Sports Cardiology, Sorrento, April 2nd–5th, 1987aGoogle Scholar
  96. Palatini P, Mos L, Munari L, Lusiani L, Ronsisvalle A, et al. Intra-arterial blood pressure during track running. Proceedings of the 9th International Symposium on Biotelemetry, Dubrovnik, October 26–31, 1986cGoogle Scholar
  97. Palatini P, Pessina AC, Ardigo A, Veronese P, Dal Palu C. Risposta ad alcuni tests pressori in pazienti con ipertensione labile e stabile, prima c dopo atenololo. Bollettino della Societa Italiana di Cardiologia 22: 1477–1484, 1977PubMedGoogle Scholar
  98. Palatini P, Pessina AC, Bozza G, Semplicini A, Veronese P, et al. Modificazioni emodinamiche indotte dal prazosin in con-dizioni basali e durante alcuni tests pressori nella ipertensione essenziale. Bollettino della Societa Italiana di Cardiologia 23: 718–725, 1978PubMedGoogle Scholar
  99. Palatini P, Pessina AC, Mos L, Munari L, Del Torre M, et al. Blood pressure pattern during dynamic exercise. 11th scientific meeting of the International Society of Hypertension, Heidelberg, August 31–September 6, 1986. Abstract no. 1042, p. 509, 1986bGoogle Scholar
  100. Palatini P, Sperti G, Cordone L, Mormino P, Di Marco A, et al. Reliability of indirect blood pressure monitoring for the eval-uation of hypertension. Clinical and Experimental Hypertension A7 (2&3): 437–443, 1985bCrossRefGoogle Scholar
  101. Pantano JA, Oriel RJ. Prevalence and nature of cardiac arrhythmias in apparently normal well-trained runners. American Heart Journal 104: 762–768, 1982PubMedCrossRefGoogle Scholar
  102. Payen DM, Safar ME, Levenson JA, Totomokono JA, Weiss YA. Prospective study of predictive factors determining borderline hypertensive individuals who develop sustained hypertension: prognostic value of increased diastolic orthostatic blood pressure tilt-test response and subsequent weight gain. American Heart Journal 103: 379–383, 1982PubMedCrossRefGoogle Scholar
  103. Pelliccia A, Caselli G, Piovano G. L’ipertensione arteriosa negli atleti. In Venerando & Zeppilli (Eds) Cardiologia dello sport, pp. 439–448, Masson Italia Editore, Milano, 1982Google Scholar
  104. Pessina AC, Palatini P, Sperti G, Cordone L, Libardoni M, et al. Evaluation of hypertension and related target organ damage by average day-time blood pressure. Clinical and Experimental Hypertension A7 (2&3): 267–278, 1985CrossRefGoogle Scholar
  105. Pickering TG, Harshfield GA, Kleinert HD, Blank S, Laragh JH. Blood pressure during normal daily activities, sleep and exercise. Journal of the American Medical Association 247: 992–996, 1982PubMedCrossRefGoogle Scholar
  106. Pollock ML, Bohannon RL, Cooper KH, Ayres JJ, Ward A. A comparative analysis of four protocols for maximal treadmill stress testing. American Heart Journal 92: 39–46, 1976PubMedCrossRefGoogle Scholar
  107. Pugh LGCE. The effect of wind resistance in running and walking and the mechanical efficiency of work against horizontal and vertical forces. Journal of Physiology (London) 213: 255–270, 1971Google Scholar
  108. Radice M, Alii C, Avanzini F, Di Tullio M, Mariotti G, et al. Role of blood pressure response to provocative tests in the prediction of hypertension in adolescents. European Heart Journal 6: 490–496, 1985PubMedGoogle Scholar
  109. Raine AEG, Pickering TG. Cardiovascular and sympathetic re-sponse to exercise after-long term beta-adrenergic blockade. British Medical Journal 2: 90–92, 1977PubMedCrossRefGoogle Scholar
  110. Rasmussen PH, Staats BA, Driscoll DJ, Beck KC, Bonekat HW, et al. Direct and indirect blood pressure during exercise. Chest 87: 743–748, 1985PubMedCrossRefGoogle Scholar
  111. Ressl J, Chrastek J, Jandova R. Hemodynamic effects of physical training in essential hypertension. Cardiologica 32: 121–133, 1977Google Scholar
  112. Reybrouck T, Amery A, Billiet L. Hemodynamic response to graded exercise after chronic beta-adrenergic blockade. Journal of Applied Physiology 42: 133–138, 1977PubMedGoogle Scholar
  113. Roman O, Camuzzi AL, Villalon E, Klenner C. Physical training program in arterial hypertension: A long-term prospective follow-up. Angiology 67: 230–243, 1981Google Scholar
  114. Rost R. Kreislaufkreaktion und-adoption unter Korpelicher Belastung. pp.93–97, Osang Verlag, Bonn, 1979Google Scholar
  115. Rost R, Hollmann W. Athlete’s heart: a review of its historical assessment and new aspects. International Journal of Sports Medicine 4: 147–165, 1983PubMedCrossRefGoogle Scholar
  116. Rowell LB, Brengelmann GL, Blackmon JR, Bruce RA, Murray JA. Disparities between aortic and peripheral pulse pressure induced by upright exercise and vasomotor changes in man. Circulation 37: 954–960, 1968PubMedCrossRefGoogle Scholar
  117. Rowell LB, Brengelmann GL, Murray JA, Kraning II KK, Kusumi F. Human metabolic response to hyperthermia during mild to maximal exercise. Journal of Applied Physiology 26: 395–402, 1969PubMedGoogle Scholar
  118. Rowlands DB, Ireland MA, Stallard TJ, Glover DR, McLeay RA, et al. Assessment of left ventricular mass and its response to anti-hypertensive treatment. Lancet 1: 467–470, 1982PubMedCrossRefGoogle Scholar
  119. Rubier S, Chu DA, Bruzzone CL. Blood pressure and heart rate responses during 24-hours ambulatory monitoring and exercise in man with diabetes mellitus. American Journal of Cardiology 55: 801–806, 1985CrossRefGoogle Scholar
  120. Rushmer RF, Franklin DL, Van Citters RL, Smith OA. Changes in peripheral blood flow distribution in healthy dogs. Circulation Research 9: 675–682, 1961PubMedCrossRefGoogle Scholar
  121. Saltin B, Sternberg J. Circulatory response to prolonged severe exercise. Journal of Applied Physiology 19: 833–838, 1964PubMedGoogle Scholar
  122. Sannerstedt R. Hemodynamic findings at rest and during exercise in patients with arterial hypertension. American Journal of Medical Science 258: 70–79, 1969CrossRefGoogle Scholar
  123. Sannerstedt R, Julius S. Systemic hemodynamics in borderline arterial hypertension: responses to static exercise before and under the influence of propranolol. Cardiovascular Research 6: 398–403, 1972PubMedCrossRefGoogle Scholar
  124. Sannerstedt R, Wasir H, Henning R, Werko L. Systemic hemodynamics in mild arterial hypertension before and after physical training. Clinical Science and Molecular Medicine 45: 145S–149S, 1973Google Scholar
  125. Sangvik K, Stokkeland M, Lindseth-Ditlefsen EM, Nyberg G. Circulation reaction at rest and during isometric and dynamic exercise in hypertensive patients: influence of different adrenergic beta-adrenoceptor antagonists. Pharmatherapeutica 1: 71–83, 1975Google Scholar
  126. Seals DR, Washburn RA, Hanson PG, Painter PL, Nagle FJ. Increased cardiovascular response to static contraction of larger muscle groups. Journal of Applied Physiology 54: 434–437, 1983PubMedGoogle Scholar
  127. Shen WF, Fletcher PJ, Roubin GS, Choong CYP, Hutton BF, et al. Comparison of effects of isometric and supine bicycle exercise on left ventricular performance in patients with aortic regurgitation and normal ejection fraction at rest. American Heart Journal 109: 1300–1305, 1985PubMedCrossRefGoogle Scholar
  128. Sheps DS, Ernst JC, Briese FW, Myerburg RJ. Exercise-induced increase in diastolic pressure: indicator of severe coronary artery disease. American Journal of Cardiology 43: 708–712, 1979PubMedCrossRefGoogle Scholar
  129. Silke B, Watt SJ, Taylor SH. The circulatory response to lifting and carrying and its modification by beta-adrenoreceptor blockade. International Journal of Cardiology 6: 527–536, 1984PubMedCrossRefGoogle Scholar
  130. Sloan PJM, Beevers DG. Hypertension and the heart. European Heart Journal 4: 215–221, 1983PubMedCrossRefGoogle Scholar
  131. Sokolow M, Werdegar D, Kain HK, Hinman HT. Relationships between level of blood pressure measured casually and by portable recorders and severity of complications in essential hyper-tension. Circulation 34: 279–298, 1966PubMedCrossRefGoogle Scholar
  132. Stefadouros MA, Grossman W, El Shahawy M, Witham AC. The effect of isometric exercise on the left ventricular volume in normal man. Circulation 49: 1185–1189, 1974PubMedCrossRefGoogle Scholar
  133. Stein DT, Lowenthal DT, Porter RS, Falkner B, Bravo EL, et al. Effects of nifedipine and verapamil on isometric and dynamic exercise in normal subjects. American Journal of Cardiology 54: 386–389, 1984PubMedCrossRefGoogle Scholar
  134. Stratton JR, Halter JB, Hallstrom AP, Caldwell JH, Ritchie JL. Comparative plasma catecholamin and hemodynamic responses to handgrip, cold pressor and supine bicycle exercise testing in normal subjects. Journal of the American College of Cardiology 2: 93–104, 1983PubMedCrossRefGoogle Scholar
  135. Strong WB. Hypertension and sport. Pediatrics 64: 693–695, 1979PubMedGoogle Scholar
  136. Tabakin BS, Hanson JS, Merriam TW, Caldwell EJ. Hemodynamic response of normal men to graded treadmill exercise. Journal of Applied Physiology 19: 457–464, 1964PubMedGoogle Scholar
  137. Thadani U, Parker JO. Hemodynamics at rest and during supine and sitting bicycle exercise in normal subjects. American Journal of Cardiology 41: 52–59, 1978PubMedCrossRefGoogle Scholar
  138. Thomson PD, Kelemen MH. Hypotension accompanying the onset of exertional angina: a sign of severe compromise of left ventricular blood supply. Circulation 52: 28–32, 1975PubMedCrossRefGoogle Scholar
  139. Tuttle WW, Horwath SM. Comparison of effects of static and dynamic work on blood pressure and heart rate. Journal of Applied Physiology 10: 294–296, 1957PubMedGoogle Scholar
  140. Tuxen DV, Sutton J, MacDougall D, Sale D. Brainstem injury following maximal weight lifting attempts. Abstract. Medicine and Science in Sport and Exercise 15: 184, 1983Google Scholar
  141. Van Citters RL, Franklin DL. Cardiovascular performance of Alaska sled dogs during exercise. Circulation Research 24: 33–42, 1969PubMedCrossRefGoogle Scholar
  142. Vatner SF, Franklin D, Higgins CB, Patrick T, Braunwald E. Left ventricular response to severe exertion in untethered dogs. Journal of Clinical Investigations 51: 3052–3060, 1972CrossRefGoogle Scholar
  143. Vatner SF, Higgins CB, White S, Patrick T, Franklin D, et al. The peripheral vascular response to severe exercise in untethered dogs before and after complete heart block. Journal of Clinical Investigations 50: 1950–1960, 1971CrossRefGoogle Scholar
  144. Walther R, Tifft C. L’ipertensione nello sportivo: linee di condotta e consigli terapeutici. Stampa Medica 30: 14–26, 1986Google Scholar
  145. Wexler J, Kao FF. Neural and humoral factors affecting canine renal blood during induced muscular work. American Journal of Physiology 218: 755–761, 1970PubMedGoogle Scholar
  146. Williams DHH, Hamley EJ. Training responses of two age groups during treadmill walking. British Journal of Sports Medicine 20: 10–13, 1986PubMedCrossRefGoogle Scholar
  147. Wilson NV, Meyer BM. Early prediction of hypertension using exercise blood pressure. Preventive Medicine 10: 62–68, 1981PubMedCrossRefGoogle Scholar
  148. Wolthuis RA, Froelicher VJ, Fischer J, Triebwasser JH. The response of healthy men to treadmill exercise. Circulation 55: 153–157, 1977PubMedCrossRefGoogle Scholar
  149. Wu SC, Secchi MB, Mancarella S, Fossa L, Bettazzi L, et al. Use-fulness of stress testing for the evaluation of hypertensive heart disease in young hypertensive subjects. Cardiology 71: 277–283, 1984PubMedCrossRefGoogle Scholar
  150. Zabetakis PM. Profiling the hypertensive patient in sports. Clinics in Sports Medicine 3: 137–151, 1984PubMedGoogle Scholar
  151. Montoye H. The Harward step test and work capacity. Revue Canadienne de Biologie 11: 491–498, 1953PubMedGoogle Scholar
  152. Morin Y, Turmel L, Fortier J. Methyldopa: clinical studies in arterial hypertension. American Journal of Medical Science 4: 633–640, 1964CrossRefGoogle Scholar

Copyright information

© ADIS Press Limited 1988

Authors and Affiliations

  • Paolo Palatini
    • 1
  1. 1.Clinica Medica IUniversity of PadovaPadovaItaly

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