Excessive blood pressure increase with exercise and risk of all-cause mortality and cardiac events

• Published in: European journal of clinical investigation Vol. 46; no. 10; pp. 833 - 839
• Main Authors: Bouzas-Mosquera, María C., Bouzas-Mosquera, Alberto, Peteiro, Jesús
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-10-2016
• Subjects: Blood pressure; Cause of Death; Coronary Artery Disease - etiology; Coronary Artery Disease - mortality; Death, Sudden, Cardiac - etiology; Exercise - physiology; Exercise Test; Female; Humans; Hypertension - etiology; Hypertension - mortality; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Prognosis; Retrospective Studies; Risk Factors; exercise test; prognosis; Blood pressure
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/eci.12665

Background
The association of an excessive blood pressure increase with exercise (EBPIE) on cardiovascular outcomes remains controversial. We sought to assess its impact on the risk of all‐cause mortality and major cardiac events in patients with known or suspected coronary artery disease (CAD) referred for stress testing.
Materials and methods
Exercise echocardiography was performed in 10 047 patients with known or suspected CAD. An EBPIE was defined as an increase in systolic blood pressure with exercise ≥ 80 mmHg. The endpoints were all‐cause mortality and major cardiac events (MACE), including cardiac death or nonfatal myocardial infarction (MI).
Results
Overall, 573 patients exhibited an EBPIE during the tests. Over a mean follow‐up of 4·8 years, there were 1950 deaths (including 725 cardiac deaths), 1477 MI and 1900 MACE. The cumulative 10‐year rates of all‐cause mortality, cardiac death, nonfatal MI and MACE were 32·9%, 13·1%, 26·9% and 33% in patients who did not develop an EBPIE vs. 18·9%, 4·7%, 17·5% and 20·7% in those experiencing an EBPIE, respectively (P < 0·001 for all comparisons). In Cox regression analyses, an EBPIE remained predictive of all‐cause mortality (hazard ratio [HR] 0·73, 95% confidence interval [CI] 0·59–0·91, P = 0·004), cardiac death (HR 0·67, 95% CI 0·46–0·98, P = 0·04), MI (HR 0·67, 95% CI 0·52–0·86, P = 0·002) and MACE (HR 0·69, 95% CI 0·56–0·86, P = 0·001).
Conclusions
An EBPIE was associated with a significantly lower risk of mortality and MACE in patients with known or suspected CAD referred for stress testing.