Exercise and Sports Science Australia (ESSA) - Consensus Statement: Exercise blood pressure for the identification of uncontrolled hypertension: recommendations to support best-practice blood pressure management.

Abstract

Objectives: High blood pressure (BP) affects >1 billion adults worldwide, with many cases undiagnosed and/or ineffectively controlled. There is a need for complementary approaches to that of in-clinic BP measurement at rest to identify uncontrolled high BP (≥140/90 mmHg). A hypertensive response to exercise (HRE) is associated with increased cardiovascular risk and likely represents poor BP control not detected via standard in-clinic BP at rest. Many clinical exercise professionals measure exercise BP as part of standard practice and are therefore uniquely placed to identify uncontrolled high BP from exercise BP. This statement was developed with the aim of providing exercise professionals with consensus and practical guidance to support best-practice BP management via the measurement of exercise BP.

Design: Exercise and Sports Science Australia (ESSA) consensus statement.

Methods: An international authorship team with research and clinical expertise covering exercise physiology, cardiology, blood pressure, and general practice was assembled to review evidence and develop a series of consensus recommendations.

Results: Exercise BP measurement has significant potential to identify individuals with uncontrolled high BP. Exercise BP should be measured using best-practice technique during fixed workload exercise that elicits up to a moderate intensity (e.g., 64 < 76 % maximal heart rate). If an HRE is recorded (exercise systolic BP ≥170 mmHg), uncontrolled high BP should be assumed and trigger: 1) correspondence with a primary care physician (PCP) encouraging follow-up testing to ascertain BP status; 2) guidance for the patient to complete home BP measurement as part of ascertaining BP status and encouragement to report their findings to a PCP; and 3) with PCP confirmation of raised BP, ongoing exercise and lifestyle intervention to lower high BP.

Conclusions: This consensus statement provides a recommended clinical pathway for clinical exercise professionals to utilise exercise BP measurement in practice and take a complementary role in the identification and management of high BP.