title: Usefulness of hypertensive blood pressure response during a single-stage exercise test to predict long-term outcome in patients with peripheral arterial disease.
abstract: The prognostic value of a hypertensive blood pressure (BP) response is still unclear. Therefore, the prognostic value of a hypertensive BP response in patients during single-stage exercise testing for peripheral arterial disease (PAD) on long-term mortality and major adverse cerebrovascular and cardiac events (MACCEs) was investigated. In addition, effects of statin, beta-blocker, and aspirin use in patients with known or suspected PAD were studied. A total of 2,109 patients were enrolled in an observational prospective study from 1993 to 2005. Hypertensive BP response was defined as an increase in systolic BP > or = 55 mm Hg (95(th) percentile within our population) after a single-stage treadmill exercise test. The outcome was obtained by using the civil registries, and a questionnaire about cardiac events was sent to all survivals. Hypertensive BP response was associated with increased risk of long-term mortality (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12 to 1.80) and MACCEs (HR 1.47, 95% CI 1.09 to 1.97). After adjustments for clinical risk factors and propensity score, baseline statin use was associated with reduced risk of long-term mortality (HR 0.59, 95% CI 0.44 to 0.79), and statin, beta-blocker, and aspirin use were associated with reduced risk of MACCEs (HR 0.59, 95% CI 0.43 to 0.81; HR 0.75, 95% CI 0.60 to 0.95; HR 0.73, 95% CI, 0.57 to 0.92, respectively). In conclusion, hypertensive BP response at exercise in patients with known or suspected PAD is an important independent risk factor for all-cause long-term mortality and MACCEs, whereas statin, beta-blocker, and aspirin use were associated with an improved outcome.
authors.affiliation: Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Inge I
authors.initials: II
authors.lastname: de Liefde
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Yvette R B M
authors.initials: YR
authors.lastname: van Gestel
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Jan
authors.initials: J
authors.lastname: Klein
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin