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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
Open accessAbstract
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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“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]
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“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]
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Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality
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Metadata
- 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.
- 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)
- 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
- bronze
- doi.org
- 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 › Physiology (medical) › 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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