Document Detail


Usefulness of paradoxical systolic blood pressure increase after exercise as a predictor of cardiovascular mortality.
MedLine Citation:
PMID:  18721505     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Exercise treadmill testing (ETT) is a well-accepted examination for patients with suspected coronary artery disease (CAD), and exercise induced ST-segment deviation is commonly used for CAD detection. However, recent evidence shows that systolic blood pressure (SBP) changes during and after exercise were associated with CAD severity, risk of acute myocardial infarction and stroke, new-onset hypertension, and even cardiovascular mortality. We retrospectively assessed 3,054 patients referred for ETT in 1996. Blood pressure and heart rate were recorded at rest, during peak exercise, and 1 and 3 min after exercise. SBP at 3 min of recovery equal to or higher than that at 1-min of recovery was defined as paradoxical SBP increase. These patients were categorized into 4 groups according to ETT ST-segment change and postexercise SBP change. After 10 years of follow-up, 346 patients (11%) died, with 129 (4%) dying from cardiovascular disease (CVD). Among the 4 groups, patients with ischemic ST-segment change and paradoxical SBP increase were associated with a higher risk for mortality, with odds ratios of 1.86 (95% confidence interval 1.31 to 2.65) for all-cause mortality and 3.18 (95% confidence interval 1.94 to 5.20) for CVD mortality, respectively. Patients with isolated paradoxical SBP increase still had a higher risk of CVD mortality (odds ratio 1.80, 95% confidence interval 1.70 to 3.04), even after controlling other cardiovascular risk factors. In subgroup analysis of 346 mortality subjects, patients with ischemic ST-segment change and paradoxical SBP increase would be more likely to die from CVD. In conclusion, compared with ischemic ST-segment change, paradoxical SBP increase after exercise is an important and significant predictor of CVD mortality.
Authors:
Chi-Lun Huang; Ta-Chen Su; Wen-Jone Chen; Lian-Yu Lin; Wen-Lin Wang; Mee-Huei Feng; Chiau-Suong Liau; Yuan-Teh Lee; Ming-Fong Chen
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-06-12
Journal Detail:
Title:  The American journal of cardiology     Volume:  102     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-25     Completed Date:  2008-09-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  518-23     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, Tao Yuan General Hospital, Tao Yuan, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Blood Pressure / physiology*
Cause of Death / trends
Confidence Intervals
Electrocardiography
Exercise Test*
Female
Follow-Up Studies
Humans
Hypertension / complications,  mortality,  physiopathology*
Male
Middle Aged
Myocardial Ischemia / diagnosis,  etiology,  mortality*
Odds Ratio
Prognosis
Retrospective Studies
Risk Factors
Survival Rate / trends
Taiwan / epidemiology

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


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