Blood Pressure During Exercise Stress Test Can Predict Incidence of Hypertension & CV Events
Treadmill exercise testing is the most common noninvasive test to assess patients with suspected or known cardiovascular disease. Measurement of blood pressure (BP) during exercise stress is cumbersome due to patient motion and hemodynamic changes during exercise. A recent study suggests that BP measurements during rest, exercise and recovery phases of exercise stress testing (EST) provides information on the long-term risk of developing hypertension and other cardiovascular events. The study findings were published online in the Journal of Hypertension in August 2021.
The physiologic response to exercise may provide valuable prognostic information. Dr Barak Zafrir and his team conducted a study to evaluate the association of blood pressure (BP) measurements during exercise stress testing (EST) with long-term risk of myocardial infarction, stroke or death (major adverse cardiovascular event, MACE), as well as the development of new-onset hypertension.
In this retrospective analysis of treadmill ESTs (years 2005–2019) performed by the Bruce protocol, the researchers included a total of 14 792 patients (48% women) without a history of cardiovascular disease. They documented BP at rest, submaximal exercise (Bruce stage-2), peak exercise and recovery (2 min). They assessed the association of SBP measures with study outcomes during a median follow-up of 6.5 years.
Key findings of the study were:
♦ They observed an increase in the adjusted hazard ratio for MACE (major adverse cardiovascular event) in relation to the highest vs lowest systolic blood pressure (SBP) quartile at
- Rest (≥140 vs <120 mmHg): HR 1.53,
- Submaximal-exercise (≥170 vs. <130 mmHg): HR 1.33,
- Peak-exercise (≥180 vs. ≤145 mmHg): HR 1.30 and
- Recovery (≥160 vs. <130 mmHg): HR 1.35, respectively.
♦ They observed a J-shaped pattern of the link between SBP at submaximal exercise and recovery with MACE.
♦ Among nonhypertensive patients (n = 8529), they found that the excessive SBP response to peak exercise (≥190 mmHg in women and ≥210 mmHg in men) was an independent predictor of hypertension [hazard ratio]: 1.87.
♦ They further noted a similar association with SBPs during submaximal exercise [>160 vs ≤130 mmHg: 2.44] and recovery [≥140 vs ≤120 mmHg: 1.65].
The authors concluded, "BP measurement during rest, exercise and recovery phases of EST provides incremental prognostic information regarding long-term risk for cardiovascular events and the probability for developing hypertension."
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