title: Exaggerated exercise blood pressure response and risk of stroke in patients referred for stress testing.
abstract: OBJECTIVE
  There is some evidence to suggest that exercise systolic blood pressure (SBP) may be associated with future risk of stroke in subjects without a history of coronary artery disease (CAD). However, the value of an exaggerated exercise SBP response (EESBPR) for predicting stroke in patients referred for stress testing for clinical reasons has not been investigated.
  
  
  METHODS
  We evaluated a community-based sample of 10,047 patients with known or suspected CAD who underwent treadmill exercise echocardiography. An EESBPR was defined as a peak exercise SBP of >220mmHg. The ratio of the increase in SBP during exercise to exercise workload (ΔSBPeEW) was also estimated. The endpoints were stroke of any type, ischemic stroke and hemorrhagic stroke. Median follow-up was 3.5years.
  
  
  RESULTS
  Annualized rates of stroke of any type, ischemic stroke and hemorrhagic stroke were 0.6% (95% CI 0.53-0.67), 0.49% (95% CI 0.42-0.56) and 0.12% (95% CI 0.09-0.15) in patients without EESBPR vs. 0.69% (95% CI 0.37-1), 0.49% (95% CI 0.23-0.76) and 0.19% (95% CI 0.02-0.35) in those with EESBPR (p=0.68, 0.90 and 0.39, respectively). Similarly, there was no significant univariate association between ΔSBPeEW and the occurrence of any endpoint. In multivariate analysis, hypertension, male sex, age, diabetes mellitus and resting SBP remained predictors of stroke of any type. EESBPR and ΔSBPeEW were not predictors of any of the endpoints evaluated.
  
  
  CONCLUSIONS
  We did not observe any significant association between exercise SBP and the future occurrence of stroke in patients with known or suspected CAD referred for exercise echocardiography.
authors.affiliation: Faculty of Health Sciences, European University, Madrid, Spain.
authors.forename: María Del Carmen
authors.initials: Mdel C
authors.lastname: Bouzas-Mosquera
authors.affiliation: Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain. Electronic address: alberto.bouzas.mosquera@sergas.es.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.affiliation: Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Peteiro
authors.affiliation: Department of Health Information Technology, Hospital Universitario A Coruña, A Coruña, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Broullón
authors.affiliation: Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain.
authors.forename: Nemesio
authors.initials: N
authors.lastname: Alvarez-García
authors.affiliation: Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D003324:Coronary Artery Disease / Q000503:physiopathology*; D048909:Diabetes Complications; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D013223:Statistics as Topic; D020521:Stroke / Q000209:etiology*; D013599:Systole
keywords: Blood pressure; Exercise test; Prognosis; Stroke