Who requires medical evaluation and ECG-monitored exercise testing before exercise?

• A. Individuals with stage 2 hypertension (SBP ≥160 or DBP ≥100).
• B. Stage 1 hypertension.
• C. Prehypertension.
• D. Normal BP.

Answer: (A)

Before starting an exercise program, clinicians assess cardiovascular risk to decide if medical evaluation and monitoring are needed during testing. Very high blood pressure is a major risk, because exercising raises the heart’s workload and can reveal or trigger problems if the vessels or heart are already under strain. When blood pressure is in stage 2 hypertension (systolic 160 or higher or diastolic 100 or higher), medical clearance is recommended, and if exercise testing is done, it should be ECG-monitored to detect ischemia or dangerous arrhythmias as the heart works harder. This ensures safety and helps tailor the exercise plan or identify any underlying heart conditions.

Stage 1 hypertension or prehypertension involve lower immediate risk for adverse events during moderate exercise, so routine ECG-monitored testing isn’t automatically required. Normal blood pressure likewise doesn’t mandate such testing solely on BP status, unless other risk factors or symptoms are present.