title: Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis.
abstract: BACKGROUND
  The prognostic relevance of a hypertensive response to exercise (HRE) is ill-defined in individuals undergoing exercise stress testing. The study described here was intended to provide a systematic review and meta-analysis of published literature to determine the value of exercise-related blood pressure (BP) (independent of office BP) for predicting cardiovascular (CV) events and mortality.
  
  
  METHODS
  Online databases were searched for published longitudinal studies reporting exercise-related BP and CV events and mortality rates.
  
  
  RESULTS
  We identified for review 12 longitudinal studies with a total of 46,314 individuals without significant coronary artery disease, with total CV event and mortality rates recorded over a mean follow-up of 15.2±4.0 years. After adjustment for age, office BP, and CV risk factors, an HRE at moderate exercise intensity carried a 36% greater rate of CV events and mortality (95% CI, 1.02-1.83, P = 0.039) than that of subjects without an HRE. Additionally, each 10mm Hg increase in systolic BP during exercise at moderate intensity was accompanied by a 4% increase in CV events and mortality, independent of office BP, age, or CV risk factors (95% CI, 1.01-1.07, P = 0.02). Systolic BP at maximal workload was not significantly associated with the outcome of an increased rate of CV, whether analyzed as a categorical (HR=1.49, 95% CI, 0.90-2.46, P = 0.12) or a continuous (HR=1.01, 95% CI, 0.98-1.04, P = 0.53) variable.
  
  
  CONCLUSIONS
  An HRE at moderate exercise intensity during exercise stress testing is an independent risk factor for CV events and mortality. This highlights the need to determine underlying pathophysiological mechanisms of exercise-induced hypertension.
authors: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
authors: Martin G
authors: MG
authors: Schultz
authors: Petr
authors: P
authors: Otahal
authors: Verity J
authors: VJ
authors: Cleland
authors: Leigh
authors: L
authors: Blizzard
authors: Thomas H
authors: TH
authors: Marwick
authors: James E
authors: JE
authors: Sharman
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D015444:Exercise / Q000502:physiology; D005080:Exercise Test / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors