Cardiopulmonary Exercise Test in Patients with Hypertension: Focused on Hypertensive Response to Exercise

The cardiopulmonary exercise test (CPET) provides integrative exercise responses including the cardiovascular, pulmonary and skeletal muscle systems. It can be used for the identification of myocardial ischemia, evaluation of exercise capacity and tolerance, and the assessment of chronotropic competence or arrhythmias with the addition of ventilatory and gas exchange measurement information. Among them, hypertensive response to exercise (HRE) is known to be related with higher risk of future heart failure and cardiovascular events in patients with hypertension. Proposed underlying mechanisms of HRE can be found in ventricular-vascular uncoupling including decreased aortic distensibility, increased left ventricular mass, endothelial dysfunction, and diastolic dysfunction. The CPET might be useful in the identification of masked hypertension and the assessment of antihypertensive treatment efficacy in patients with hypertension.