Comparison of manual and automated auscultatory blood pressure during graded exercise among people with type 2 diabetes

A new and specific automated blood pressure device for exercise stress testing

Blood pressure (BP) measurement plays a critical role in cardiac stress testing and is most commonly assessed manually. The emphasis of social distancing during the COVID-19 pandemic has renewed the interest in and the need for an automated BP device for incremental exercise stress testing. We assessed the accuracy of a new automated blood pressure device specifically manufactured for cardiac stress testing. Thirty-five adults aged 35 ± 16 years were studied during an incremental stress test on the cycle ergometer. Three observers measured BP simultaneously, two listening to Korotkoff sounds using a dual-headed stethoscope and one using headphones to listen to sounds generated by an automated BP device. With increasing workload, systolic BP increased progressively without significant differences in BP readings between any observer compared with the automated monitor at any stage during exercise. Systolic BP obtained with the BP machine was strongly correlated with those obtained by the stethoscope observers (r = 0.96) and the observer with headphones (r = 0.95). Diastolic BP obtained with the BP machine was moderately and significantly associated with those obtained by the stethoscope observers (r = 0.75) and the observer with headphones (r = 0.75). The automated BP monitor specifically made for cardiac stress testing accurately measured both systolic and diastolic blood pressure during exercise.

The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance

High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identification of high BP is conventionally based on in-clinic (resting) BP measures, performed within primary health care settings. However, many cases of high BP go unrecognised or remain inadequately controlled. Thus, there is a need for complementary settings and methods for BP assessment to identify and control high BP more effectively. Exaggerated exercise BP is associated with increased CVD risk and may be a medium to improve identification and control of high BP because it is suggestive of high BP gone undetected on the basis of standard in-clinic BP measures at rest. This paper provides the evidence to support a pathway to aid identification and control of high BP in clinical exercise settings via the measurement of exercise BP. It is recommended that exercise professionals conducting exercise testing should measure BP at a fixed submaximal exercise workload at moderate intensity (e.g., ~70% age-predicted heart rate maximum, stage 1-2 of a standard Bruce treadmill protocol). If exercise systolic BP is raised (≥170 mmHg), uncontrolled high BP should be assumed and should trigger correspondence with a primary care physician to encourage follow-up care to ascertain true BP control (i.e., home, or ambulatory BP) alongside a hypertension-guided exercise and lifestyle intervention to lower CVD risk related to high BP.