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Andreas Zeller, Daniel Handschin, Niklaus Gyr, Benedict Martina & Edouard
Battegay
To cite this article: Andreas Zeller, Daniel Handschin, Niklaus Gyr, Benedict Martina & Edouard
Battegay (2004) Blood pressure and heart rate of students undergoing a medical licensing
examination, Blood Pressure, 13:1, 20-24, DOI: 10.1080/08037050310025645
Article views: 29
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BLOOD PRESSURE 2004; 13: 20±24
Zeller A, Handschin D, Gyr N, Martina B, Battegay E. Blood pressure and heart rate of students
undergoing a medical licensing examination. Blood Pressure 2004; 13: 20–24.
Aims: To assess the effect of a real life mental stress situation on blood pressure (BP) and heart rate (HR)
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in students undergoing a medical licensing examination. Method: Prospective observational study of 121
medical students taking the final licensing exam. BP and HR were taken before and after the exam.
Additionally, BP was measured by ambulatory BP monitoring device and HR was recorded continuously
by an HR monitor belt in 25 students throughout the examination. Major findings: Diastolic BP (DBP)
increased from 81 10 mmHg before the exam to 86 9 mmHg (p = 0.008) during the exam and to
88 11 mmHg, (p = 0.007) 15 min after the exam. Systolic BP (SBP) did not increase significantly
during (from 131 14 before the exam to 136 18 mmHg) and after the exam (135 16 mmHg). HR
decreased during (to 100 18 beats/min, p < 0.001), and after the exam (to 95 19 beats/min,
p < 0.001) compared to values before the exam (114 19 beats/min). SBP was higher in male students
compared to female students before (138 10 vs 125 18 mmHg) and after (126 18 vs
115 17 mmHg) the exam (p < 0.01). Conclusion: Only DBP increased during medical licensing
examination, albeit within a small range. SBP did not change significantly and HR decreased during the
exam. Male students showed a higher SBP compared to female students. Key words: blood pressure,
cardiovascular reactivity, medical education, medical examination, mental stress.
Table I. Blood pressure (BP) and heart rate in all students RESULTS
(n = 121) before the examination measured by sphygmo-
manometry (mean standard deviation) Of 121 students enrolled, 57 (47.1%) were men and 64
(52.9%) were women, aged 25–29 years. All 121 students
Characteristics of students before the examination (n = 121) had BP readings by sphygmomanometry before the exam.
Systolic BP 132 17 mmHg Characteristics of the all studied subjects are summarized
Diastolic BP 81 8 mmHg in Table I. There was no difference of SBP and DBP in
Heart rate 112 18 beats/min students with positive or negative family history of
History of hypertension None of the students hypertension.
Family history of hypertension 36/121 (29.8%) Eight (32%) of 25 students investigated by ABPM had
BP values >140 and/or 90 mmHg before the exam.
Nineteen students (76%) showed an initial HR > 100
beats/min (highest measured HR 153 beats/min). Mean
SBP and DBP, and HR before, during and after the exam
Labs1) and asked to wear an HR monitoring belt
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Table II. Blood pressure (BP) and heart rate (HR) during a medical licensing examination in 25 students measured by
ambulatory BP monitoring device
Systolic BPa (mean SD) (mmHg) Diastolic BPb (mean SD) (mmHg) HRb (mean SD) (beats/min)
Before oral exam 131 14 81 10 114 19
During oral exam 136 18 86 9 100 18
After oral exam 135 16 88 11 95 19
SD, standard deviation. aNo significant changes in SBP. bSignificant increase in DPB (p < 0.0001), significant decrease in HR
(p > 0.0007).
Table III. Blood pressure and heart rate estimated by students and effectively measured before and after exam in all
students (n = 121)
SBP, systolic blood pressure in mmHg; DBP, diastolic blood pressure in mmHg; HR, heart rate in beats per minute; ns, not
significant. Blood pressure measurement by mercury sphygmomanometry. aStudents t-test.
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