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- Title
Excessive blood pressure increase with exercise and risk of all-cause mortality and cardiac events.
- Authors
Bouzas‐Mosquera, María C.; Bouzas‐Mosquera, Alberto; Peteiro, Jesús
- Abstract
Background The association of an excessive blood pressure increase with exercise ( EBPIE) on cardiovascular outcomes remains controversial. We sought to assess its impact on the risk of all-cause mortality and major cardiac events in patients with known or suspected coronary artery disease ( CAD) referred for stress testing. Materials and methods Exercise echocardiography was performed in 10 047 patients with known or suspected CAD. An EBPIE was defined as an increase in systolic blood pressure with exercise ≥ 80 mmHg. The endpoints were all-cause mortality and major cardiac events ( MACE), including cardiac death or nonfatal myocardial infarction ( MI). Results Overall, 573 patients exhibited an EBPIE during the tests. Over a mean follow-up of 4·8 years, there were 1950 deaths (including 725 cardiac deaths), 1477 MI and 1900 MACE. The cumulative 10-year rates of all-cause mortality, cardiac death, nonfatal MI and MACE were 32·9%, 13·1%, 26·9% and 33% in patients who did not develop an EBPIE vs. 18·9%, 4·7%, 17·5% and 20·7% in those experiencing an EBPIE, respectively ( P < 0·001 for all comparisons). In Cox regression analyses, an EBPIE remained predictive of all-cause mortality (hazard ratio [ HR] 0·73, 95% confidence interval [ CI] 0·59-0·91, P = 0·004), cardiac death ( HR 0·67, 95% CI 0·46-0·98, P = 0·04), MI ( HR 0·67, 95% CI 0·52-0·86, P = 0·002) and MACE ( HR 0·69, 95% CI 0·56-0·86, P = 0·001). Conclusions An EBPIE was associated with a significantly lower risk of mortality and MACE in patients with known or suspected CAD referred for stress testing.
- Subjects
BLOOD pressure; EXERCISE physiology; CARDIOVASCULAR diseases; PATIENTS; ECHOCARDIOGRAPHY; CORONARY artery bypass; MYOCARDIAL infarction
- Publication
European Journal of Clinical Investigation, 2016, Vol 46, Issue 10, p833
- ISSN
0014-2972
- Publication type
Article
- DOI
10.1111/eci.12665