Beta-blockade mitigates exercise blood pressure in hypertensive male patients

J Am Coll Cardiol. 2006 Feb 21;47(4):794-8. doi: 10.1016/j.jacc.2005.09.057. Epub 2006 Jan 30.


Objectives: The purpose of this study was to determine the antihypertensive agent(s) more likely to mitigate an exaggerated rise in exercise blood pressure (BP) in hypertensive patients.

Background: An exaggerated rise in exercise BP is associated with increased cardiovascular risk. There are no recommendations for treating such response.

Methods: Participants were hypertensive men (n = 2,318; age 60 +/- 10 years), undergoing a routine exercise test at the Veterans Affairs Medical Center, Washington, DC. Antihypertensive therapy included angiotensin-converting enzyme inhibitors (n = 437), calcium-channel blockers (n = 223), diuretics (n = 226), and combinations (n = 1,442), beta-blockers alone (n = 201) or in combination with other antihypertensive agents (n = 467), and none (n = 208). Exercise BP, heart rate (HR) and rate-pressure product (RPP) at maximal and submaximal workloads were assessed.

Results: After adjusting for covariates, patients treated with beta-blockers or beta-blocker-based therapy had significantly lower BP, HR, and RPP at 5 and 7 metabolic equivalents (METs) and peak exercise than those treated with any other antihypertensive agent or combination (p < 0.05). The likelihood of achieving an exercise systolic BP of >/=210 mm Hg was 68% lower (odds ratio = 0.32, 96% confidence interval 0.2 to 0.53) in the beta-blocker-based therapy versus other medications. African Americans exhibited higher BP and HR than Caucasians at all exercise workloads regardless of antihypertensive therapy and had over a 90% higher likelihood for an abnormal exercise BP response. This risk was attenuated by 35% with a beta-blocker-based therapy.

Conclusions: Significantly lower exercise BP, HR, and RPP levels are achieved with beta-blocker-based therapy than with other antihypertensive agents regardless of race. However, BP was better controlled in Caucasians than in African Americans regardless of antihypertensive therapy.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Antihypertensive Agents / administration & dosage*
  • Black People
  • Blood Pressure / drug effects*
  • Drug Therapy, Combination
  • Exercise Test*
  • Hemodynamics
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / ethnology
  • Hypertension / physiopathology
  • Male
  • Middle Aged
  • White People


  • Adrenergic beta-Antagonists
  • Antihypertensive Agents