The prognostic value of post-exercise blood pressure reduction in patients with hypertensive response during exercise stress test.
BACKGROUND
Hypertensive response at peak-exercise and during the recovery phase of exercise stress test (ET) is associated with poor cardiovascular prognosis. We investigated whether decrease in blood pressure (BP) from peak to post-exercise would identify a subgroup at higher cardiovascular risk.


METHODS
Eighty-six non-hypertensive patients (0-4 cardiovascular risk factors) with hypertensive reaction at peak-ET (systolic>180 mm Hg and/or diastolic>100 mm Hg) were divided based on BP 5 min after exercise termination into two groups: Normal response (NrmR) (<160/90 mm Hg), Hypertensive response (HypR) (>/=160/90 mm Hg). Five years later the prevalence of cardiovascular risk factors and cardiovascular morbidity and mortality was assessed for each group.


RESULTS
Both groups had similar pre- and peak-exercise BP. However the HypR group had higher post-exercise BP (systolic: 163+/-13 vs. 125+/-14 mm Hg, respectively, p<0.01, and diastolic: 74+/-6 vs. 75+/-4 mm Hg, respectively, p<0.01), smaller decrease in BP after exercise (Delta systolic: 46.9+/-3.1 vs. 73.9+/-3.6 mm Hg, respectively, p<0.01, Delta diastolic: 12.4+/-1.5 vs. 26.5+/-2.2 mm Hg, respectively, p<0.01), and higher post- than pre-exercise BP (Delta systolic: 24.5+/-3.5 vs. -6+/-4.1 mm Hg, respectively, p<0.01, A diastolic: 19+/-2.1 vs. -13+/-2.3 mm Hg, respectively, p<0.01). Five years later, HypR group had higher prevalence of abnormal cholesterol serum level (p<0.01), hypertension (p<0.01) and combined ischemic heart disease and cerebrovascular disease (RR 1.32, 95% CI=1.13-1.54, p<0.01).


CONCLUSIONS
During ET evaluation, it is important to evaluate the BP at 5 min after exercise because reduced BP drop, at this routinely measured point, identifies a subgroup with higher cardiovascular risk.
Yosefy
Chaim
C
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, 55 Fruit St., VBK 508, Harvard Medical School, Boston, MA, USA. yosefy@barzi.health.gov.il
Jafari
Jamal
J
Klainman
Eliezer
E
Brodkin
Boris
B
Handschumacher
Mark D
MD
Vaturi
Mordehay
M
D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors