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Exercise Prescription & Programming

2017 ACC Guidelines for High Blood Pressure
Lori Saiia
Regarding the 2017 ACC Guideline for High Blood Pressure, has anyone changed their limits for BP response during exercise relative to these guidelines? Our CR department believes we should now terminate exercise when SBP ≥180 based on these guidelines. ACSM GTEP 10th ed (p. 127) states a hypertensive response to exercise is SBP ≥210 in men and ≥190 in women. I believe these new ACC Guidelines are for “detection, evaluation and management” of high blood pressure not necessarily blood pressure response in exercise. Any thoughts?
Mark Patterson
Hi Lori, Good question. If you look at GTEP on pages 228-229 you will see recommendations in regard to exercise and BP for the cardiac population. It states that a resting BP of 180/110 would be a reason to NOT start exercise. Then during exercise there is really no mention of upper limit on systolic BP, but an upper limit of 110 for diastolic BP during exercise. So, using a cut off of 180 mmHg systolic during exercise is not suggested, but remember this data is a few years old by the time of publication, so if there is new information out there, this may be somewhat out of date.

Generally in practice, I agree with just exercise that the 180/110 is not a bad guideline to not START exercise, but it is a guideline and not a rule. Considering the time and effort people take to see us, you might consider someone who comes in with a BP that high to just take a quick, 2 minute walk and then reassess. I do this routinely with stress testing where someone is rather high, then I have them walk flat on the treadmill for a couple of minutes at 2 mph, reassess BP, then if it drops a little, will then start the protocol.

During exercise testing the guidelines are 250 for top systolic BP and is still only a relative contraindication to stopping testing if there is valuable information in pushing further, although I have never pushed anyone past that point anyway.

Essentially it is a case by case basis. If they cannot get good overall control of BP and even with easy to moderate efforts they are routinely in the 200's, then you might want them to take some time and work with their physician to get better overall control medially.

If they are running just a little over the recommendations and you can adjust the exercise protocol accordingly, then I think it is more important to do the exercise to assist with control of their BP.

Hope this was helpful
Lori Saiia
Thank you so much Mark for taking the time to answer my question. I appreciate your help - and completely agree! Thank you again!
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