Systolic Blood Pressure Response During Exercise Stress Testing

The Henry Ford ExercIse Testing (FIT) Project

Wesley T. O'Neal, Waqas T. Qureshi, Michael Blaha, Steven J. Keteyian, Clinton A. Brawner, Mouaz H. Al-Mallah

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The prognostic significance of modest elevations in exercise systolic blood pressure response has not been extensively examined.

METHODS AND RESULTS: We examined the association between systolic blood pressure response and all-cause death and incident myocardial infarction (MI) in 44 089 (mean age 53±13 years, 45% female, 26% black) patients who underwent exercise treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project (1991-2010). Exercise systolic blood pressure response was examined as a categorical variable (>20 mm Hg: referent; 1 to 20 mm Hg, and ≤0 mm Hg) and per 1 SD decrease. Cox regression was used to compute hazard ratios (HR) and 95% CI for the association between systolic blood pressure response and all-cause death and incident MI. Over a median follow-up of 10 years, a total of 4782 (11%) deaths occurred and over 5.2 years, a total of 1188 (2.7%) MIs occurred. In a Cox regression analysis adjusted for demographics, physical fitness, and cardiovascular risk factors, an increased risk of death was observed with decreasing systolic blood pressure response (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.13, 95% CI=1.05, 1.22; ≤0 mm Hg: HR=1.21, 95% CI=1.09, 1.34). A trend for increased MI risk was observed (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.09, 95% CI=0.93, 1.27; ≤0 mm Hg: HR=1.19, 95% CI=0.95, 1.50). Decreases in systolic blood pressure response per 1 SD were associated with an increased risk for all-cause death (HR=1.08, 95% CI=1.05, 1.11) and incident MI (HR=1.09, 95% CI=1.03, 1.16).

CONCLUSIONS: Our results suggest that modest increases in exercise systolic blood pressure response are associated with adverse outcomes.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume4
Issue number5
DOIs
StatePublished - May 7 2015

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Exercise
Blood Pressure
Myocardial Infarction
Cause of Death
Physical Fitness
Regression Analysis
Demography

Keywords

  • blood pressure
  • death
  • myocardial infarction
  • stress testing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Systolic Blood Pressure Response During Exercise Stress Testing : The Henry Ford ExercIse Testing (FIT) Project. / O'Neal, Wesley T.; Qureshi, Waqas T.; Blaha, Michael; Keteyian, Steven J.; Brawner, Clinton A.; Al-Mallah, Mouaz H.

In: Journal of the American Heart Association, Vol. 4, No. 5, 07.05.2015.

Research output: Contribution to journalArticle

O'Neal, Wesley T. ; Qureshi, Waqas T. ; Blaha, Michael ; Keteyian, Steven J. ; Brawner, Clinton A. ; Al-Mallah, Mouaz H. / Systolic Blood Pressure Response During Exercise Stress Testing : The Henry Ford ExercIse Testing (FIT) Project. In: Journal of the American Heart Association. 2015 ; Vol. 4, No. 5.
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abstract = "BACKGROUND: The prognostic significance of modest elevations in exercise systolic blood pressure response has not been extensively examined.METHODS AND RESULTS: We examined the association between systolic blood pressure response and all-cause death and incident myocardial infarction (MI) in 44 089 (mean age 53±13 years, 45{\%} female, 26{\%} black) patients who underwent exercise treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project (1991-2010). Exercise systolic blood pressure response was examined as a categorical variable (>20 mm Hg: referent; 1 to 20 mm Hg, and ≤0 mm Hg) and per 1 SD decrease. Cox regression was used to compute hazard ratios (HR) and 95{\%} CI for the association between systolic blood pressure response and all-cause death and incident MI. Over a median follow-up of 10 years, a total of 4782 (11{\%}) deaths occurred and over 5.2 years, a total of 1188 (2.7{\%}) MIs occurred. In a Cox regression analysis adjusted for demographics, physical fitness, and cardiovascular risk factors, an increased risk of death was observed with decreasing systolic blood pressure response (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.13, 95{\%} CI=1.05, 1.22; ≤0 mm Hg: HR=1.21, 95{\%} CI=1.09, 1.34). A trend for increased MI risk was observed (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.09, 95{\%} CI=0.93, 1.27; ≤0 mm Hg: HR=1.19, 95{\%} CI=0.95, 1.50). Decreases in systolic blood pressure response per 1 SD were associated with an increased risk for all-cause death (HR=1.08, 95{\%} CI=1.05, 1.11) and incident MI (HR=1.09, 95{\%} CI=1.03, 1.16).CONCLUSIONS: Our results suggest that modest increases in exercise systolic blood pressure response are associated with adverse outcomes.",
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N2 - BACKGROUND: The prognostic significance of modest elevations in exercise systolic blood pressure response has not been extensively examined.METHODS AND RESULTS: We examined the association between systolic blood pressure response and all-cause death and incident myocardial infarction (MI) in 44 089 (mean age 53±13 years, 45% female, 26% black) patients who underwent exercise treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project (1991-2010). Exercise systolic blood pressure response was examined as a categorical variable (>20 mm Hg: referent; 1 to 20 mm Hg, and ≤0 mm Hg) and per 1 SD decrease. Cox regression was used to compute hazard ratios (HR) and 95% CI for the association between systolic blood pressure response and all-cause death and incident MI. Over a median follow-up of 10 years, a total of 4782 (11%) deaths occurred and over 5.2 years, a total of 1188 (2.7%) MIs occurred. In a Cox regression analysis adjusted for demographics, physical fitness, and cardiovascular risk factors, an increased risk of death was observed with decreasing systolic blood pressure response (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.13, 95% CI=1.05, 1.22; ≤0 mm Hg: HR=1.21, 95% CI=1.09, 1.34). A trend for increased MI risk was observed (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.09, 95% CI=0.93, 1.27; ≤0 mm Hg: HR=1.19, 95% CI=0.95, 1.50). Decreases in systolic blood pressure response per 1 SD were associated with an increased risk for all-cause death (HR=1.08, 95% CI=1.05, 1.11) and incident MI (HR=1.09, 95% CI=1.03, 1.16).CONCLUSIONS: Our results suggest that modest increases in exercise systolic blood pressure response are associated with adverse outcomes.

AB - BACKGROUND: The prognostic significance of modest elevations in exercise systolic blood pressure response has not been extensively examined.METHODS AND RESULTS: We examined the association between systolic blood pressure response and all-cause death and incident myocardial infarction (MI) in 44 089 (mean age 53±13 years, 45% female, 26% black) patients who underwent exercise treadmill stress testing from the Henry Ford ExercIse Testing (FIT) Project (1991-2010). Exercise systolic blood pressure response was examined as a categorical variable (>20 mm Hg: referent; 1 to 20 mm Hg, and ≤0 mm Hg) and per 1 SD decrease. Cox regression was used to compute hazard ratios (HR) and 95% CI for the association between systolic blood pressure response and all-cause death and incident MI. Over a median follow-up of 10 years, a total of 4782 (11%) deaths occurred and over 5.2 years, a total of 1188 (2.7%) MIs occurred. In a Cox regression analysis adjusted for demographics, physical fitness, and cardiovascular risk factors, an increased risk of death was observed with decreasing systolic blood pressure response (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.13, 95% CI=1.05, 1.22; ≤0 mm Hg: HR=1.21, 95% CI=1.09, 1.34). A trend for increased MI risk was observed (>20 mm Hg: HR=1.0, referent; 1 to 20 mm Hg: HR=1.09, 95% CI=0.93, 1.27; ≤0 mm Hg: HR=1.19, 95% CI=0.95, 1.50). Decreases in systolic blood pressure response per 1 SD were associated with an increased risk for all-cause death (HR=1.08, 95% CI=1.05, 1.11) and incident MI (HR=1.09, 95% CI=1.03, 1.16).CONCLUSIONS: Our results suggest that modest increases in exercise systolic blood pressure response are associated with adverse outcomes.

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