Prognostic value of the increase in systolic blood pressure with exercise in patients with hypertension and known or suspected coronary artery disease.
OBJECTIVE
The association of an exaggerated systolic blood pressure increase with exercise (EBPIE) with cardiovascular events remains controversial. Our aim was to determine the possible association of an EBPIE with survival and risk of serious cardiac events in patients with hypertension and known or suspected coronary artery disease (CAD).


METHODS
This is a retrospective observational study based on a sample of 5226 patients with a history of arterial hypertension and known or suspected CAD referred for exercise echocardiography. The EBPIE was defined as an increase in systolic blood pressure with exercise greater than or equal to the 95th percentile of this population (80mmHg). The end points were all-cause mortality, cardiac death and myocardial infarction (MI).


RESULTS
During a mean follow-up of 4.7 years, there were 978 deaths (including 371 cardiac) and 798 MI. Annual rates of all-cause mortality, cardiac mortality and MI were 2.73, 0.83 and 2.63% in patients with EBPIE and 4.4, 1.58 and 3.98% in those without EBPIE (P<.001, P=.012, and P=.014, respectively). After multivariate analysis, an EBPIE remained independently associated with a lower risk of all-cause mortality (HR: 0.70, 95% CI: 0.52-0.95; P=.023) and MI (HR: 0.69, 95% CI: 0.50-0.95; P=.022) but was not significantly associated with cardiac mortality (HR: 0.72, 95% CI: 0.43-1.20; P=.2).


CONCLUSIONS
EBPIE was associated with an increased likelihood of survival and lower rate of MI in hypertensive patients with known or suspected CAD.
Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, España. Electronic address: mariadelcarmen.bouzas@universidadeuropea.es.
Carmen
C
Bouzas-Mosquera
Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Hospital Universitario A Coruña, La Coruña, España.
Alberto
A
Bouzas-Mosquera
Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Hospital Universitario A Coruña, La Coruña, España.
Jesús
J
Peteiro
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D004452:Echocardiography; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
Arterial hypertension; Ejercicio; Exercise; Hipertensión arterial; Hypertensive response; Prognosis; Pronóstico; Respuesta hipertensiva