SYSTEMIC HYPERTENSION

Relation of Blood Pressure

During
Exercise te Anaerobic Metabolism
DALE W. SPENCE, EdD, LYSLE H. PETERSON, MD,
and VINCENT E. FRIEDEWALD, Jr., MD

To determine the effects of anaerobic metabolism

on blood pressure (BP), 25 subjects were studied
for BP response to graded and continuous leg-
crank ergometry under both aerobic and anaerobic
condi- tions. Measurements obtained during
exercise also included ventilatory equivalents for
oxygen and car- bon dioxide to determine
anaerobic threshold. Sys- tolic and diastolic BP
responses to exercise before anaerobic threshold
were compared with responses after anaerobic
threshold by linear regression analy- ses. The
systolic BP response to graded exercise

The effect of exercise on systolic, mean and diastolic

blood pressure (BP) has been shown to increase
linear- ly with increased oxygen use during exercise'
and with proportionately increasing workloads.2 " In
addi- tion, systolic BP as a function of metabolic
expenditure increases proportionately among healthy
adult men up to 10 METs of expenditure, with even
greater in- creases in older subjects.4 Our experience
with several hundred subjects, including adults of
both sexes with and without disease, has revealed a
subset that did not have an expected linear response
of BP to proportion- ately increasing exercise loads.
In the subjects in this study, we first observed a
rapid and exaggerated in- crease in systolic BP
during routine graded exercise test evaluation using
the Balke treadmill protocol, as observed by several
previous studies." In our earlier study, the rapid
elevation of systolic BP occurred at moderate levels
of exercise (5 to 6 METs). Because the shift from
aerobic toward anaerobic processes typical- ly occurs
at these levels of exercise in untrained sub- jects, a
possible association between these phenomena was
explored. The present study investigates an ap-
parent nonlinear response of BP to proportionately
graded exercise in 25 subjects with respect to
anaero- bic metabolism.
Frum the Comprehensive Rehabilitation Center, Houston,
Tex- its. This study was supported by the Houston
Cardiovascular Rehabilitation Foundation and American
Medical Intornation-
‹il, Houston, Texas. Manuscript received October 28, 1986; re-
vised manuscript received and accepted January 13, 1987.
Ad£lross for reprints: Dale W. Spence, EdD, Department of
F(cnlth and Physical Education, Rice University, P.O. Box
1892,
was significantly accelerated (p TO.01) after
an- aerobic threshold, demonstrating a nonlinear
re- sponse to proportionately graded exercise
demand. Comparison of the slopes or rates of
change in dia- stolic BP before and after
anaerobic threshold also indicated a significant
difference (p TO.01) under these 2 different
metabolic conditions. It is conclud- ed that in
contrast to the linear response of BP un- der
conditions of aerobic metabolism, BP responds
nonlinearly during anaerobic metabolism.
(Am J Cardiol 1987;59:1342—1344)
Methods
Subjects: The 25 study subjects were
sedentary men (mean age 46 years) who had
had exercise-in- duced, rapid hypertension
during a graded exercise test evaluation. The
group had subjects with both nor- motensive (n =
16) and hypertensive (n = 9) BPs at rest. Exercise
protocol: Baseline determinations of BP and
metabolic parameters were obtained during a 3-
minute period, followed by a graded exercise test
on a calibrated leg-crank ergometer. Each 3-
1342
minute stage of the exercise test represented a 25-W
power increase from the previous stage. BP and
metabolism were measured each minute during the
test. The test was terminated at the end of the 3-
minute stage during which the subject reached 200
mm Hg systolic or 100 mm Hg diastolic BP. In 5
subjects, leg fatigue preempt- ed these criteria for
test termination. All subjects achieved a workload
of at least 100 W during the exer-
cise test.
Blood pressure: BP was determined using a
stetho- scope fitted with a Diasyst (Dupaco) sound
transducer that was placed beneath the occluding
cuff over the brachial artery. The occluding cuff was
inflated by an electric pump, which subsequently
deflated the cuff linearly over time. The pressure
decrease was set for a deflation rate of 10 mm Hg/s.
The cuff was inflated 20 seconds before the minute;
thus, the measurement co- incided with the metabolic
determination at each min- ute. The cuff pressure
was determined by a mercurial manometer. During
BP determination, the subject's arm was stabilized
at a standard elevation.
Gas exchange: One-minute measurements of
oxy- gen utilization, carbon dioxide output,
ventilation vol-
 June 1, 1987 THE AMERICAN JOURNAL OF CARDIOLOGY Volume 59 1343

re-
ume, respiratory exchange ratio and end-tidal
oxygen were determined using a Beckman metabolic
mea- surement cart. Calibration of the metabolic
instrument using standard reference gasses and
volumes was done before and after each test. From
these basic mea- surements, the ventilatory
equivalents for oxygen and carbon dioxide were
computed.
Anaerobic threshold: The anaerobic threshold
was determined by comparing ventilatory
equivalents for oxygen and carbon dioxide. During
the early stages of graded exercise, both ventilatory
equivalents decrease as a result of a decreasing ratio
of physiologic dead space to tidal volume. With
increasing intensity of ex- ercise, the ventilatory
equivalents continue to de- crease but less steeply.
However, with the onset of anaerobic processes, the
ventilatory equivalent for oxygen begins to increase
but without a concomitant increase in the ventilatory
equivalent for carbon diox- ide.8 Thus, the breakpoint
of increasing ventilatory equivalent for oxygen
without a concomitant increase in the ventilatory
equivalent for carbon dioxide was the indicator for
determining anaerobic threshold in this study. In
some subjects, the breakpoints of ventila- tion
volume, end-tidal oxygen and the respiratory ex-
change ratio were also examined to corroborate
anaer- obic threshold. These various ventilation
breakpoints or thresholds for determining the onset
of anaerobic processes have been reported to show
close agreement with the onset of blood lactate
accumulation," ' and therefore are suitable markers
for detecting the transi- tion into anaerobic
metabolism.

Blood pressure and metabolism: To test the rela-

tion of the onset of anaerobic metabolism and acceler-
ated BP response, the mean values of BP across sub-
jects were compared before and after the point of
anaerobic threshold (Table I). Because our subjects
reached this metabolic event at varing times and at
different workloads because of varying levels of
exer- cise tolerance and metabolic capacity, we
compared BP in relation to the time periods before
and after anaerobic threshold.
Figures 1 and 2 reflect the preceding comparisons
and standardize BP in all subjects to the same
metabol- ic event. Linear regression lines were
estimated for the 2 physiologic states. The predictecl
estimate of systolic BP as a function of time before
anaerobic threshold =
143.2 -1- 1.6 X min ', and after anaerobic threshold =
152.6 -1- 2.2 X min ' (Fig. 1). The difference between
the slopes or rates of change in systolic BP before
and after anaerobic threshold were tested by a paired
t test using each subj ect's individual regression lines,
and found to be statistically significant (p <0.01]. The
pre- dicted estimate of diastolic BP as a function of time
before anaerobic threshold = 85.5 + 0.45 X min 1, and
after anaerobic threshold = 99.0 — 0.39 X min* ' (Fig.
2]. The difference between the slopes or rates of
change in diastolic BP before and after anaerobic
threshold were tested by the same procedure and
also found to be statistically significant (p 40.01]. We
did not find a significant difference in exercise BP
TABLE I Mean Values of Determinations Taken During a
Graded Exercise Test on a Leg-Crank Ergometer
Standardized to the Time of Anaerobic Threshold

Systemic BP
(mm Hg)
Relative Load
Time (W) S D VO, R VE/VCO, VE/VO,

14 25 140 84 0.34 0.95 3.60 3.50

—13 25 150 94 0.47 0.83 3.17 2.67
—12 25 140 83 0.40 0.85 3.12 2.70
—11 29 143 88 0.47 0.99 2.92 2.98
—10 30 138 81 0.45 0.86 2.86 2.58
—9 30 154 94 0.55 0.91 2.67 2.48
—8 30 151 87 0.51 0.90 2.94 2.70
—7 34 150 86 0.58 0.92 2.77 2.62
—6 39 151 87 0.63 0.90 2.60 2.38
—5 43 148 89 0.67 0.90 2.52 2,32
—4 49 151 89 0.71 0.91 2.50 2.31
—3 54 157 90 0.74 0.92 2.43 2.30
—2 63 163 89 0.87 0.94 2.33 2.25
—1 72 167 91 0.94 0.97 2.23 2.27
+1 88 177 93 1.07 1.05 2.23 2.42
^2 96 183 94 1.17 1.07 2.21 2.44
+3 102 187 94 1.25 1.10 2.21 2.50
-1-4 111 191 93 1.34 1.12 2.21 2.55
+5 119 189 93 1.42 1.14 2.23 2.55
+6 130 197 93 1.50 1.18 2.23 2.66
+7 135 192 94 1.52 1.21 2.26 2.56
+8 138 187 96 1.60 1.22 2.30 2.62
+9 150 192 86 1.60 1.20 1.90 2.30
—1-10 150 204 90 1.70 1.27 2.02 2.40
+11 150 200 90 1.86 1.27 2.02 2.40

BP = blood pressure; D = diastolic; Load = ergometer resistance; R

respiratory exchange ratio; Relative Time = time in minutes before and after
anaerobic threshold; S' systolic; VE/VCOz ' ventilatory equivalent for car-
bon dioxide; \/E/VO, = ventilatory equivalent for oxygen; VO, = oxygen uti-
lization in liters/min STPD.

sponse of the hypertensive subjects compared with

that in the normotensive subjects of the study group.
Discussion
The disproportionate increase in systolic BP ob-
served during anaerobic metabolism was also
evident, but of lower magnitude, immediately
preceding an- aerobic threshold. This observation
may be related to

210

200
SBP2
190

180

170
SBP1
160

150

140

130
-14 -12 -10 -8 —6 -4 -2 0 2 4 6 8 10
12
Minutes Relative to Anaerobic Threshold
FIGURE 1. Best-fit linear regression lines to mean systolic blood
pressure before (SBP1) and after (SBP2) anaerobic threshold.
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