Usefulness of paradoxical systolic blood pressure increase after exercise as a predictor of cardiovascular mortality

The American Journal of Cardiology
Chi-Lun HuangMing-Fong Chen

Abstract

Exercise treadmill testing (ETT) is a well-accepted examination for patients with suspected coronary artery disease (CAD), and exercise induced ST-segment deviation is commonly used for CAD detection. However, recent evidence shows that systolic blood pressure (SBP) changes during and after exercise were associated with CAD severity, risk of acute myocardial infarction and stroke, new-onset hypertension, and even cardiovascular mortality. We retrospectively assessed 3,054 patients referred for ETT in 1996. Blood pressure and heart rate were recorded at rest, during peak exercise, and 1 and 3 min after exercise. SBP at 3 min of recovery equal to or higher than that at 1-min of recovery was defined as paradoxical SBP increase. These patients were categorized into 4 groups according to ETT ST-segment change and postexercise SBP change. After 10 years of follow-up, 346 patients (11%) died, with 129 (4%) dying from cardiovascular disease (CVD). Among the 4 groups, patients with ischemic ST-segment change and paradoxical SBP increase were associated with a higher risk for mortality, with odds ratios of 1.86 (95% confidence interval 1.31 to 2.65) for all-cause mortality and 3.18 (95% confidence interval 1.94 to 5.20) for CVD mortality...Continue Reading

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Citations

Jun 9, 2009·Appetite·Mendel RabinIvan Carlos Ferreira Antonello
Mar 6, 2013·The Journal of Clinical Hypertension·Andreas P MichaelidesChristodoulos I Stefanadis
Oct 3, 2014·Journal of Human Hypertension·J E Sharman, A LaGerche
Sep 15, 2016·Journal of Child and Adolescent Psychopharmacology·Arthur N WestoverEthan A Halm
Dec 2, 2011·Journal of Human Hypertension·L HolmqvistK Manhem
Jul 24, 2013·Circulation·Gerald F FletcherUNKNOWN American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology,
Jan 19, 2013·Journal of Cardiovascular Medicine·Matteo BartoliniRoberto Sciagrà
Dec 10, 2013·Journal of Hypertension·Jari A LaukkanenRainer Rauramaa
Mar 19, 2016·Journal of Clinical Psychopharmacology·Arthur N WestoverLaura F DeFina

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