title: Prognostic value of an exaggerated exercise blood pressure response in patients with diabetes mellitus and known or suspected coronary artery disease.
abstract: The prognostic value of an exaggerated exercise systolic blood pressure response (EESBPR) remains controversial. Our aim was to assess whether an EESBPR is associated with the long-term outcome in patients with diabetes mellitus and known or suspected coronary artery disease (CAD). From an initial population of 22,262 patients with known or suspected CAD who underwent treadmill exercise electrocardiography or exercise echocardiography at our institution, 2,591 patients with a history of diabetes mellitus were selected for the present study. EESBPR was defined as systolic blood pressure >220 mm Hg during exercise. The end points were all-cause mortality and hard events (ie, death or myocardial infarction). A total of 236 patients (9.1%) developed an EESBPR during the tests. During a mean follow-up of 6.5 +/- 3.9 years, 484 patients died and 646 experienced hard events. The 10-year mortality rate was 16.6% in patients with an EESBPR compared to 30.9% in those without an EESBPR (p <0.001). The 10-year hard event rate was also lower in patients with an EESBPR (23.2% vs 38.9% in patients without an EESBPR; p <0.001). On multivariate analysis, an EESBPR remained independently associated with a lower risk of all-cause mortality (hazard ratio 0.53, 95% confidence interval 0.36 to 0.78, p = 0.001) and hard events (hazard ratio 0.57, 95% confidence interval 0.41 to 0.79; p <0.001). These results remained consistent in the subgroup of patients without a known history of CAD. In conclusion, an EESBPR was associated with improved survival and a lower rate of death or myocardial infarction in patients with diabetes mellitus and known or suspected CAD.
authors.affiliation: Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain. aboumos@canalejo.org
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.forename: Jesús
authors.initials: J
authors.lastname: Peteiro
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Broullón
authors.forename: Nemesio
authors.initials: N
authors.lastname: Alvarez-García
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-Bueno
authors.forename: Victor X
authors.initials: VX
authors.lastname: Mosquera
authors.forename: Oscar
authors.initials: O
authors.lastname: Prada
authors.forename: Sheyla
authors.initials: S
authors.lastname: Casas
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011379:Prognosis