Abstract 19901: Significance of an Increase in Diastolic Blood Pressure During a Stress Test in Terms of Comorbidities and Long-Term Total and CV Mortality

• Published in: Circulation (New York, N.Y.) Vol. 134; no. Suppl_1 Suppl 1; p. A19901
• Main Authors: Sydó, Nóra, Sydó, Tibor, Merkely, Béla, Hussain, Nasir, Farooq, Shausha, Carta, Karina G, Lopez-Jimenez, Francisco, Murphy, Joseph G, Allison, Thomas G
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 11-11-2016
• ISSN: 0009-7322; 1524-4539

IntroductionA gradual decrease in diastolic blood pressure (DBP) with exercise is considered a normal response, but the significance of an increase in DBP with exercise has not been validated.HypothesisTo determine the significance of an increase in DBP on a stress test in terms of comorbidities and long-term total and CV mortality.MethodsOur stress test database was reviewed from 1994-2010 taking the first test performed by a given patient. Non-Minnesota residence, baseline CV disease, rest DBP 100 mmHg, and age < 30 or ≥ 80 were exclusion criteria. DBP response was classified normal if peak DBP - rest DBP was < 0, borderline if 0-9, abnormal if ≥ 10 mmHg. Mortality was determined from Mayo Clinic records and the Minnesota Death Index. Logistic regression was used to determine the relationship of DBP response to presence of obesity (BMI ≥ 30 kg/m), hypertension and diabetes from medical records, and current smoking by self-report. Cox regression was used to determine long-term total and CV mortality risk according to DBP response. All analyses were adjusted for age, sex, and resting DBP. Level of significance was set at .05.Results20760 qualifying stress tests were identified. There were 7314 females (35%). Age averaged 51 ± 11 years. Rest/peak averaged DBP 82 ± 8/69 ± 15 in normal vs. 79 ± 9/82 ± 9 in borderline vs. 76 ± 9/92 ± 11 mmHg in abnormal DBP response. There were 1582 deaths (7.6%) with 557 (2.7%) CV deaths over 12 ± 5 years follow-up. The Table shows rates of obesity, hypertension, diabetes, and current smoking along with odds ratios and [95% confidence intervals] plus rates and hazard ratios and [95% confidence intervals] for death and CV death for borderline and abnormal vs. normal DBP response.ConclusionsDiastolic blood pressure response to exercise is significantly associated with the prevalence of obesity, hypertension, diabetes, and current smoking at the time of the stress test but does not add significantly to the prognostic yield of the stress test.