title: Systolic blood pressure response to exercise testing is related to the risk of acute myocardial infarction in middle-aged men.
abstract: BACKGROUND
  We assessed the association of systolic blood pressure response to exercise with the risk of an acute myocardial infarction.
  
  
  METHODS
  We conducted a population-based follow-up study.
  
  
  METHODS
  This study was based on 1731 middle-aged men without history of coronary heart disease who underwent a cycle ergometer exercise test. Systolic blood pressure was measured every 2 min during a cycle ergometer exercise test in 1731 men followed for 12.7 years on average. A total of 188 acute myocardial infarctions were observed.
  
  
  RESULTS
  The total change in systolic blood pressure, the slope of the rise in systolic blood pressure per minute and maximal systolic blood pressure during exercise in quintiles were related to the risk of acute myocardial infarction. Maximal systolic blood pressure of over 230 mmHg was associated with a 2.47 [95% confidence interval (CI) 1.46-4.18] fold risk of acute myocardial infarction, after adjustment for age, other risk factors including the use of antihypertensive medications and systolic blood pressure at rest. Among men with elevated systolic blood pressure at rest, the relative risk for an acute myocardial infarction was 4.31 (95% CI 2.04-9.07) times higher for those who had a steep slope of systolic blood pressure rise (>9.4 mmHg per min of exercise) as compared with those who had a more gradual rise in systolic blood pressure.
  
  
  CONCLUSIONS
  Both rate and levels of rise in systolic blood pressure during a progressive exercise test were risk predictors for acute myocardial infarction. These measurements provide an incremental predictive value for an acute myocardial infarction to elevated resting systolic blood pressure, emphasizing the importance of regular blood pressure measurements during exercise testing.
authors.affiliation: Research Institute of Public Health, University of Kuopio, Kuopio, Finland. jariantero.laukkanen@uku.fi
authors.forename: Jari A
authors.initials: JA
authors.lastname: Laukkanen
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kurl
authors.forename: Rainer
authors.initials: R
authors.lastname: Rauramaa
authors.forename: Timo A
authors.initials: TA
authors.lastname: Lakka
authors.forename: Juha M
authors.initials: JM
authors.lastname: Venäläinen
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Salonen
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D005080:Exercise Test; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D013599:Systole
chemical_list: D000959:Antihypertensive Agents