Diagnostic and prognostic value of exercise testing

Blood pressure response to exercise test and serum lipids in normotensive men with positive family history of hypertension

The aim of the study was to follow the arterial blood pressure response to exercise test and serum lipids in middle-aged normotensive men with family history (FH) of arterial hypertension. 152 normotensive men, divided into two groups: I group--92 men without FH for arterial hypertension and II group--60 men with family history for arterial hypertension were investigated. The response of blood pressure to exercise test on bicycle ergometer with progressively increasing workload up to 100 W was followed up. Five minute recovery period was followed, too. The total cholesterol (TC), high-density and low-density lipoprotein cholesterol (HDL-C and LDL-C) and triglycerides were assessed and TC/HDL-C ratio was calculated. Significant difference in the arterial blood pressure at a level of 100 W between the Ist and IInd group was found: 177 +/- 19.0/ 89 +/- 12.0 mmHg versus 189 +/- 17**/ 96 +/- 11* mmHg (* p < 0.01, ** p < 0.001). Subjects with positive FH for arterial hypertension showed higher elevation of arterial blood pressure during and after exercise: OR = 2.3 (95% CI 1.1 -4.8). The systolic blood pressure during the recovery period and TC/HDL-C ratio were significantly higher with the Ilnd group. In conclusion, our data show significantly higher reaction of blood pressure to exercise, retarded recovery of blood pressure and significantly higher TC/HDL-C ratio with the individuals with positive FH for arterial hypertension.

A comparison of symptom provocation procedures in psychiatry and other areas of medicine: implications for their ethical use in research

BACKGROUND

Symptom provocation is used to study a wide variety of medical disorders. In contrast to other areas of medicine, the application of these procedures to the study of mental disease has generated significant scientific, political, and public debate. Purported differences include an overabundance of these procedures in psychiatry and a lack of diagnostic and therapeutic utility. Accurate appraisal of these research designs is needed to address scientific merit and ethical concerns. This article provides a general review of challenge studies in several areas of medical research, compares purposes and methods to those used in psychiatry, and ascertains whether fundamental differences exist.

METHODS

In total, 655 challenge studies were identified using MEDLINE and PsychInfo Boolean key word searches. Information was collected from each study including the year of publication, whether subjects were healthy or patient volunteers, the disease being studied, and the study purpose (e.g., to study pathophysiology, test treatment efficacy, or diagnosis of a disorder).

RESULTS

Differences in study design, purpose, and frequency of studies across time were similar for medical and psychiatric diseases.

CONCLUSIONS

Given extensive similarity in purpose and procedures, why are psychiatric challenge studies being subjected to public criticism and special review and approval procedures? Several relevant issues are addressed including risk, scientific merit, and clinical application.