Document Detail


Prognostic value of hypotensive blood pressure response during single-stage exercise test on long-term outcome in patients with known or suspected peripheral arterial disease.
MedLine Citation:
PMID:  19005295     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: A decline in systolic blood pressure during exercise is thought to be a sign of severe coronary artery disease. However, no studies have yet examined this effect in patients with known or suspected peripheral arterial disease. Therefore, we investigated the prognostic value of hypotensive blood pressure response after single-stage exercise test on long-term mortality, major adverse cerebrovascular and cardiac events (MACCE) and the effects of statin, beta-blocker and aspirin use in patients with known or suspected peripheral arterial disease. METHODS: A total of 2022 patients were enrolled in an observational study with a mean follow-up of 5 years. Hypotensive blood pressure response, 4.6% of the total population, was defined as a drop in exercise systolic blood pressure below resting systolic blood pressure. RESULTS: Our study showed that hypotensive blood pressure response was associated with an increased risk of all-cause mortality [hazard ratio (HR): 1.74, 95% confidence interval (CI): 1.10-2.73] and MACCE (HR: 1.85, 95% CI: 1.14-3.00), independent of other clinical variables. Additionally, after adjustments for clinical risk factors and propensity score, baseline statin use was associated with a reduced risk of all-cause mortality (HR: 0.60, 95% CI: 0.44-0.80). Besides, statin and aspirin use were both also associated with a reduced risk of MACCE (HR: 0.65, 95% CI: 0.47-0.89 and HR: 0.69, 95% CI: 0.53-0.88, respectively). CONCLUSION: Hypotensive blood pressure response after single-stage treadmill exercise tests in patients with known or suspected peripheral arterial disease was associated with a higher risk for all-cause long-term mortality and MACCE, which might be reduced by statin and aspirin use.
Authors:
Inge I de Liefde; Sanne E Hoeks; Yvette R B M van Gestel; Jan Klein; Hence J M Verhagen; Ron T van Domburg; Don Poldermans
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Coronary artery disease     Volume:  19     ISSN:  1473-5830     ISO Abbreviation:  Coron. Artery Dis.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-13     Completed Date:  2009-02-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9011445     Medline TA:  Coron Artery Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  603-7     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Aged
Aspirin / therapeutic use
Blood Pressure*
Cardiovascular Diseases / etiology*,  mortality,  physiopathology,  prevention & control
Exercise Test*
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Hypotension / etiology*,  physiopathology
Male
Middle Aged
Odds Ratio
Peripheral Vascular Diseases / complications,  diagnosis*,  mortality,  physiopathology,  therapy
Platelet Aggregation Inhibitors / therapeutic use
Prognosis
Proportional Hazards Models
Risk Assessment
Time Factors
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin

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