| Exercise blood pressure and future cardiovascular death in asymptomatic individuals. | |
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MedLine Citation:
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PMID: 20439788 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Sandra A Weiss; Roger S Blumenthal; A Richey Sharrett; Rita F Redberg; Samia Mora |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-05-03 |
Journal Detail:
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Title: Circulation Volume: 121 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-18 Completed Date: 2010-06-07 Revised Date: 2011-09-26 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2109-16 Citation Subset: AIM; IM |
Affiliation:
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Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Blood Pressure / physiology* Exercise / physiology* Exercise Test Female Follow-Up Studies Heart Rate / physiology Humans Hypertension / mortality*, physiopathology* Kaplan-Meier Estimate Male Middle Aged Prevalence Proportional Hazards Models Risk Factors |
| Grant Support | |
ID/Acronym/Agency:
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K08 HL094375/HL/NHLBI NIH HHS; K08 HL094375-01/HL/NHLBI NIH HHS; K08 HL094375-02/HL/NHLBI NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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