Document Detail


Prognostic value of an exaggerated exercise blood pressure response in patients with diabetes mellitus and known or suspected coronary artery disease.
MedLine Citation:
PMID:  20211319     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The prognostic value of an exaggerated exercise systolic blood pressure response (EESBPR) remains controversial. Our aim was to assess whether an EESBPR is associated with the long-term outcome in patients with diabetes mellitus and known or suspected coronary artery disease (CAD). From an initial population of 22,262 patients with known or suspected CAD who underwent treadmill exercise electrocardiography or exercise echocardiography at our institution, 2,591 patients with a history of diabetes mellitus were selected for the present study. EESBPR was defined as systolic blood pressure >220 mm Hg during exercise. The end points were all-cause mortality and hard events (ie, death or myocardial infarction). A total of 236 patients (9.1%) developed an EESBPR during the tests. During a mean follow-up of 6.5 +/- 3.9 years, 484 patients died and 646 experienced hard events. The 10-year mortality rate was 16.6% in patients with an EESBPR compared to 30.9% in those without an EESBPR (p <0.001). The 10-year hard event rate was also lower in patients with an EESBPR (23.2% vs 38.9% in patients without an EESBPR; p <0.001). On multivariate analysis, an EESBPR remained independently associated with a lower risk of all-cause mortality (hazard ratio 0.53, 95% confidence interval 0.36 to 0.78, p = 0.001) and hard events (hazard ratio 0.57, 95% confidence interval 0.41 to 0.79; p <0.001). These results remained consistent in the subgroup of patients without a known history of CAD. In conclusion, an EESBPR was associated with improved survival and a lower rate of death or myocardial infarction in patients with diabetes mellitus and known or suspected CAD.
Authors:
Alberto Bouzas-Mosquera; Jes?s Peteiro; Francisco J Broull?n; Nemesio Alvarez-Garc?a; Lourdes Garc?a-Bueno; Victor X Mosquera; Oscar Prada; Sheyla Casas; Alfonso Castro-Beiras
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-09     Completed Date:  2010-03-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  780-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Hospital Universitario A Coru?a, A Coru?a, Spain. aboumos@canalejo.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure*
Cause of Death
Coronary Artery Disease / complications,  physiopathology*
Diabetes Mellitus / physiopathology*
Echocardiography
Electrocardiography
Exercise Test*
Female
Follow-Up Studies
Heart Rate
Humans
Male
Middle Aged
Myocardial Infarction / mortality
Prognosis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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