Document Detail

Exercise blood pressure and future cardiovascular death in asymptomatic individuals.
MedLine Citation:
PMID:  20439788     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Individuals with exaggerated exercise blood pressure (BP) tend to develop future hypertension. It is controversial whether they have higher risk of death from cardiovascular disease (CVD).
METHODS AND RESULTS: A total of 6578 asymptomatic Lipid Research Clinics Prevalence Study participants (45% women; mean age, 46 years; 74% with untreated baseline BP <140/90 mm Hg [nonhypertensive]) performing submaximal Bruce treadmill tests were followed for 20 years (385 CVD deaths occurred). Systolic and diastolic BP at rest, Bruce stage 2, and maximal BP during exercise were significantly associated with CVD death. When we compared multivariate hazard ratios and 95% confidence intervals per 10/5-mm Hg BP increments, the association was strongest for rest BP (systolic, 1.21 [1.14 to 1.27]; diastolic, 1.20 [1.14 to 1.26]), then Bruce stage 2 BP (systolic, 1.09 [1.04 to 1.14]; diastolic, 1.09 [1.05 to 1.13]), then maximal exercise BP (systolic, 1.06 [1.01 to 1.10]; diastolic, 1.04 [1.01 to 1.08]). Overall, exercise BP was not significant after adjustment for rest BP. However, hypertension status modified the risk associated with exercise BP (P(interaction)=0.03). Among nonhypertensives, whether they had normal BP (<120/80 mm Hg) or prehypertension, Bruce stage 2 BP >180/90 versus < or =180/90 mm Hg carried increased risk independent of rest BP and risk factors (adjusted hazard ratio for systolic, 1.96 [1.40 to 2.74], P<0.001; diastolic, 1.48 [1.06 to 2.06], P=0.02) and added predictive value (net reclassification improvement, systolic, 12.0% [-0.1% to 24.2%]; diastolic, 9.9% [-0.3% to 20.0%]; relative integrated discrimination improvement, 14.3% and 12.0%, respectively).
CONCLUSIONS: In asymptomatic individuals, elevated exercise BP carried higher risk of CVD death but became nonsignificant after accounting for rest BP. However, Bruce stage 2 BP >180/90 mm Hg identified nonhypertensive individuals at higher risk of CVD death.
Sandra A Weiss; Roger S Blumenthal; A Richey Sharrett; Rita F Redberg; Samia Mora
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-05-03
Journal Detail:
Title:  Circulation     Volume:  121     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-18     Completed Date:  2010-06-07     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2109-16     Citation Subset:  AIM; IM    
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MeSH Terms
Blood Pressure / physiology*
Exercise / physiology*
Exercise Test
Follow-Up Studies
Heart Rate / physiology
Hypertension / mortality*,  physiopathology*
Kaplan-Meier Estimate
Middle Aged
Proportional Hazards Models
Risk Factors
Grant Support
K08 HL094375/HL/NHLBI NIH HHS; K08 HL094375/HL/NHLBI NIH HHS; K08 HL094375-01/HL/NHLBI NIH HHS; K08 HL094375-02/HL/NHLBI NIH HHS

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