title: Systolic Blood Pressure Response During Exercise Stress Testing: The Henry Ford ExercIse Testing (FIT) Project.
abstract: BACKGROUND
  The prognostic significance of modest elevations in exercise systolic blood pressure response has not been extensively examined.
  
  
  RESULTS
  We examined the association between systolic blood pressure response and all-cause death and incident myocardial infarction (MI) in 44 089 (mean age 53±13 years, 45% female, 26% black) patients who underwent exercise treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project (1991-2010). Exercise systolic blood pressure response was examined as a categorical variable (>20 mm Hg: referent; 1 to 20 mm Hg, and ≤0 mm Hg) and per 1 SD decrease. Cox regression was used to compute hazard ratios (HR) and 95% CI for the association between systolic blood pressure response and all-cause death and incident MI. Over a median follow-up of 10 years, a total of 4782 (11%) deaths occurred and over 5.2 years, a total of 1188 (2.7%) MIs occurred. In a Cox regression analysis adjusted for demographics, physical fitness, and cardiovascular risk factors, an increased risk of death was observed with decreasing systolic blood pressure response (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.13, 95% CI=1.05, 1.22; ≤0 mm Hg: HR=1.21, 95% CI=1.09, 1.34). A trend for increased MI risk was observed (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.09, 95% CI=0.93, 1.27; ≤0 mm Hg: HR=1.19, 95% CI=0.95, 1.50). Decreases in systolic blood pressure response per 1 SD were associated with an increased risk for all-cause death (HR=1.08, 95% CI=1.05, 1.11) and incident MI (HR=1.09, 95% CI=1.03, 1.16).
  
  
  CONCLUSIONS
  Our results suggest that modest increases in exercise systolic blood pressure response are associated with adverse outcomes.
authors.affiliation: Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (W.T.N.).
authors.forename: Wesley T
authors.initials: WT
authors.lastname: O'Neal
authors.affiliation: Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (W.T.Q.).
authors.forename: Waqas T
authors.initials: WT
authors.lastname: Qureshi
authors.affiliation: Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K., C.A.B., M.H.A.M.).
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K., C.A.B., M.H.A.M.).
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Brawner
authors.affiliation: Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K., C.A.B., M.H.A.M.) Department of Internal Medicine, Wayne State University, Detroit, MI (M.H.A.M.) Department of Cardiac Imaging, King Abdul Aziz Cardiac Center, Riyadh, Saudi Arabia (M.H.A.M.).
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002423:Cause of Death; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D010809:Physical Fitness / Q000502:physiology; D012307:Risk Factors; D013312:Stress, Physiological / Q000502:physiology*; D013599:Systole / Q000502:physiology
keywords: blood pressure; death; myocardial infarction; stress testing