Hypertensive response during submaximal step exercise as a diagnostic test for arterial hypertension

Introduction: Hypertensive response to exercise (HRE) is associated with changes in mechanisms that control blood pressure (BP); although its prognostic value is well known, the evidence of its diagnostic validity is limited. Objective: Evaluate the operational characteristics of HRE to detect the presence of hypertension. Methods: A cross-sectional study to assess the validity of a diagnostic test, which included middle-aged (40-60) subjects of both sexes, with suspected BP alterations. HRE was defined as systolic BP levels greater than 150 mmHg after the Dundee step test. The presence of hypertension was defined with 24-hour ambulatory blood pressure monitoring. Results: We include 124 patients with an average age of 50.5 ± 5.9 years; 54.0% were women. The frequency of HRE was 57.3% while that of hypertension was 78.2%. HRE had a sensitivity of 59.8% (95% CI 49.5 to 70.1); specificity of 51.9% (95% CI 31.2 to 72.6); positive predictive value of 81.7% (95% CI 72.0 to 91.4); negative predictive value of 26.4% (95% CI 13.6 to 39.2): LR + of 1.2 (95% CI 0.8 to 1.9) and LR- of 0.8 (95% CI 0.5 to 1.2) to detect the presence of hypertension. Conclusion: HRE during a submaximal step test, does not have appropriate operating characteristics to detect hypertension in middle-aged patients with suspected BP alterations; therefore, it is not recommended as a diagnostic method.