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Cited by 127Blood Pressure and Hypertension StudiesCardiac Imaging and DiagnosticsCardiovascular and exercise physiology

Angiographic and prognostic implications of an exaggerated exercise systolic blood pressure response and rest systolic blood pressure in adults undergoing evaluation for suspected coronary artery disease

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Lauer, Michael S., Pashkow, Fredric J., Harvey, Sharon A., Marwick, Thomas H., Thomas, James D.·1995·Journal of the American College of Cardiology
DOI 10.1016/0735-1097(95)00388-6
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Abstract

Objectives This study was designed to assess the angiographic and prognostic implications of an exaggerated systolic blood pressure response to exercise ("exercise hypertension") in adults undergoing evaluation for suspected coronary artery disease. Background The clinical implications of exercise hypertension are unclear. Methods Subjects for this prospective cohort study were derived from a consecutive sample of 9,608 adults who were referred for treadmill testing and who augmented their systolic blood pressure by at least 10 mm Hg. There were 594 subjects who underwent coronary angiography within 90 days of treadmill testing. Exercise hypertension was defined as a peak exercise systolic blood pressure > or = 210 mm Hg in men and > or = 190 mm Hg in women. Severe angiographic coronary disease was defined as left main coronary artery disease (> or = 50% diameter stenosis), three-vessel disease (> or = 70% diameter stenosis) or two-vessel disease with > or = 70% diameter stenosis of the proximal left anterior descending coronary artery. All-cause mortality was assessed during a follow-up period of approximately 2 years. Results Exercise hypertension was present in 196 subjects (33%). Severe coronary disease was less common in subjects with exercise hypertension (14% vs. 25%, odds ratio 0.51, 95% confidence interval [CI] 0.32 to 0.81, p = 0.004). Exercise hypertension remained associated with a lower rate of severe coronary disease even after adjusting for rest hypertension, age, gender, exercise capacity and other possible confounders. During the follow-up period, there were 23 deaths; only 2 occurred in the group with exercise hypertension. After adjusting for severity of coronary disease, exercise hypertension remained associated with a lower mortality rate (adjusted relative risk 0.20, 95% CI 0.05 to 0.84, p = 0.03). Conclusions In adults evaluated for coronary artery disease, exercise hypertension is associated with a lower likelihood of angiographically severe disease and a lower adjusted mortality rate.

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  • Individualized ramp protocols that involve nonuniform increases in workload tailored to the individual allow appropriate assessment of cardiorespiratory fitness.

    “Alternatively, individualized ' ramp ' protocols that involve nonuniform increases in workload tailored to the individual, although allowing appropriate assessment of cardiorespiratory fitness (28)”

    From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [28]

    The Exercise testing passage (page unavailable) describes standard Bruce and modified Bruce treadmill protocols and estimates exercise capacity from published MET tables. A search for individualized ramp protocols and cardiorespiratory-fitness assessment found no passage addressing whether such protocols allow appropriate assessment. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Individualized ramp protocols that involve nonuniform increases in workload tailored to the individual do not allow for interindividual comparisons in the exercise blood pressure response because workloads at which blood pressure is recorded are nonstandardized.

    “Alternatively, individualized ' ramp ' protocols that involve nonuniform increases in workload tailored to the individual, although allowing appropriate assessment of cardiorespiratory fitness (28), do not allow for interindividual comparisons in the exercise BP response given the nonstandardized workloads at which time BP is recorded.”

    From Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing (2022) · cites this paper as [28]

    Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

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Research works printed but not linked: 1

  1. SAS Institute. SAS/STAT User's Guide, Vol. 2. 4th ed. Cary, NC: SAS Institute, 1990.

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Authors
Lauer, M. S., Pashkow, F. J., Harvey, S. A., Marwick, T. H., & Thomas, J. D.
Affiliations
Cleveland Clinic (US)
Corresponding author
Lauer, Michael S.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1995-12
Volume
26
Issue
7
Pages
1630-1636
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/0735-1097(95)00388-6
OpenAlex
W2081670767
Cited by
127
References
19
Citations by year
2026: 2 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 7 · 2020: 2 · 2019: 7 · 2018: 3 · 2017: 12 · 2016: 5 · 2015: 2 · 2014: 7 · 2013: 2 · 2012: 5
FWCI
1.80
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
coronary artery disease, coronary angiography, treadmill exercise testing, all-cause mortality, prognosis, left main coronary artery disease, three-vessel coronary artery disease
MeSH terms
Blood Pressure, Coronary Disease, Electrocardiography, Exercise Test, Female, Humans, Hypertension, Male, Middle Aged, Prognosis, Prospective Studies, Systole, Cohort Studies, Coronary Angiography

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