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Lee, Park, Bae, Lee, Jang, Yang, Park, Cho, Chae, and Jun: Blood Pressure Response during the Exercise Treadmill Test and the Risk of Future Hypertension and Cardiovascular Disease
Original Article
Korean Circulation Journal

Korean Circulation Journal 2007; 37(6): 277-282.

Published online: 30 June 2007

DOI: https://doi.org/10.4070/kcj.2007.37.6.277

Blood Pressure Response during the Exercise Treadmill Test and the Risk of Future Hypertension and Cardiovascular Disease

Soon Hak Lee, MD, Wee Hyun Park, MD, Myung Whan Bae, MD, Sang Hyuck Lee, MD, Se Yong Jang, MD, Dong Heon Yang, MD, Hun Sik Park, MD, Yong Keun Cho, MD, Shung Chull Chae, MD, Jae Eun Jun, MD

Division of Cardiology, Department of Internal Medicine, Kyungpook National University Medical School, Daegu, Korea.

Corresponding author (ehpark@knu.ac.kr)

Received 21 March 2007       Revised 25 April 2007       Accepted 8 May 2007

© 2007, The Korean Society of Circulation

Abstract

Background and Objectives

Many studies had established the risk factors for cardiovascular disease. The Duke treadmill score has gained widespread acceptance for making the prognosis and diagnosis for patients with cardiac disease. Recently, the changes in blood pressure during and after exercise have also been studied to predict the prognosis of cardiac disease. We examined the relationship between the incidence of hypertension or cardiovascular disease and the changes of blood pressure during a routine exercise treadmill test.

Subjects and Methods

256 men were screened, and they performed exercise treadmill tests from March to May, 2000. Those subjects with histories of hypertension and ischemic heart disease or who were newly diagnosed with ischemic heart disease were excluded. 109 subjects were selected for the final analysis. The follow up period was 78 months. Review of medical records and telephone interviews were used for follow up. We defined clinical events as new onset hypertension, ischemic heart disease, congestive heart failure, cerebrovascular accident, diabetes and atrial fibrillation. The peak systolic blood pressure of 182.5mmHg had the highest specificity and sensitivity on the receiver operating characteristic (ROC) curve of the systolic blood pressure for prediction of clinical events. We defined a hypertensive response as a peak systolic blood pressure over 180 mmHg.

Results

43 (39.4%) of the subjects had a hypertensive response on their exercise treadmill test. The mean exercise capacity was higher in the hypertensive response group. No significant differences were found between the hypertensive and non-hypertensive response groups, in terms of age, gender, body weight, height, body mass index and resting blood pressure. 18 (41.8%) of the hypertensive response subjects had clinical events, while only 11 (16.6%) of the non-hypertensive response subjects had clinical events. The hypertensive response group had more clinical events (p=0.006). 14 (32.5%) of the hypertensive response subjects had hypertension, while only 10 (15.1%) of the non-hypertensive response group had hypertension. The hypertensive response group had more hypertension (p=0.044). On the multivariate analysis, the hypertensive response on the exercise treadmill test was an independent risk factor for hypertension and clinical events (odds ratio=3.990, 95% confidence interval; 1.473-10.808, p=0.006).

Conclusion

These results indicate that the exercise blood pressure response seems to be a risk factor for hypertension and clinical events. Careful medical care and close follow up may be needed for subjects with a hypertensive blood pressure response on the exercise treadmill test. Further study is needed to understand the significance of an exaggerated blood pressure response on the exercise treadmill test.

Keywords: Electrocardiography, Exercise test, Hypertension, Cardiovascular disease

Figures and Tables

Fig. 1
ROC curve of systolic blood pressure for the prediction of clinical events. Peak systolic blood pressure of 182.5 mmHg had highest specificity and sensitivity in this ROC curve (sensitivity=0.448, specificity=0.887). We defined hypertensive response as peak systolic blood pressure over 180 mmHg. ROC: receiver operating characteristic, SBP: systolic blood pressure.
kcj-37-277-g001
Fig. 2
Changes of BP and HR during the exercise treadmill test. A: changes of systolic blood pressure during the exercise treadmill test were higher in the hypertenisve response group compared to the non-hypertensive. B: changes of diastolic blood pressure during the exercise treadmill test were higher in the hypertenisve response group compared to the non-hypertensive. C: changes of heart rate during the exercise treadmill test were not different in the hypertensive response group compared to the non-hypertensive. SBP: systolic blood pressure, St: standing, Su: supine, S1-2: modified bruce stage 1-2, DBP: diastolic blood pressure, HR: heart rate, BP: blood pressure.
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Table 1
Baseline characteristics of subjects with and without clinical events
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29 patients had newly clinical events (26.6%). Data are expressed as the mean±SD. BMI: body mass index, SBP: systolic blood pressure, DBP: diastolic blood pressure, METS: metabolic equivalents for oxygen consumption

Table 2
Demography and exercise parameters by blood pressure response
kcj-37-277-i002

43 subjects had hypertensive response. data are expressed as the mean±SD. BMI: body mass index, SBP: systolic blood pressure, DBP: diastolic blood pressure, METS: metabolic equivalents for oxygen consumption

Table 3
Clinical events in hypertensive and non-hypertensive response group
kcj-37-277-i003

4 of 29 subjects had hypertension and one other cardiovascular disease. 18 of the hypertensive response subjects had clinical events, while only 11 of the non-hypertensive. The hypertensive response group had higher clinical events (p=0.006). 14 of the hypertensive response subjects had hypertension , while only 10 of the non-hypertensive. The Hypertensive response group had higher hypertension (p=0.044)

Table 4
Multivariate analysis for clinical events
kcj-37-277-i004

In multivariate analysis, hypertensive response was independent risk factor for clinical events (p=0.006). BP: blood pressure, BMI: body mass index, SBP: systolic blood pressure

Table 5
Multivariate analysis for hypertension
kcj-37-277-i005

In multivariate analysis, hypertensive response was independent risk factor for hypertension (p=0.031). BP: blood pressure, BMI: body mass index, SBP: systolic blood pressure

References

1. Jackson AS, Squires WG, Grimes G, Bread EF. Prediction of future resting hypertension from exercise blood pressure. J Cardiopulm Rehabil. 1983. 3:263–268.
2. Miyai N, Arita M, Miyashita K, Morioka I, Shiraishi T, Nishio I. Blood pressure response to heart rate during exercise test and risk of future hypertension. Hypertension. 2002. 39:761–766.
3. Trenkwalder P, Hendricks P, Schoniger R, Rossberg J, Lydtin H, Hense HW. Hypertension as a risk factor for cardiovascular morbidity and mortality in an elderly German population; the prospective STEPHY II study. Eur Heart J. 1999. 20:1752–1756.
4. Filipovsky J, Ducimetiere P, Safar ME. Prognostic significance of exercise, blood pressure, and heart rate in middle-aged men. Hypertension. 1992. 20:333–339.
5. Sallis JF, Broyles SL, Nader PR, et al. Blood pressure reactivity to exercise: stability, determinants, family aggregation, and prediction. J Dev Behav Pediatr. 1991. 12:162–170.
6. Pickering TG, Harshfield GA, Kleinert HD, Blank S, Laragh JH. Blood pressure during normal daily activities, sleep and exercise. JAMA. 1982. 247:992–996.
7. Franz IW. Assessment of blood pressure response during ergometric work in normotensive and hypertensive patients. Acta Med Scand Suppl. 1982. 670:35–47.
8. Franz IW. Ergometry in the assessment of arterial hypertension. Cardiology. 1985. 72:147–159.
9. Kim HJ, Lee WS, Kwon JH, et al. Relationship between exercise-induced blood pressure response and left ventricular hypertrophy in patients with hypertension. Korean Circ J. 2001. 31:809–814.
10. Gottdiener JS, Brown J, Zoltick J, Fletcher RD. Left ventricular hypertrophy in men with normal blood pressure: relation to exaggerated blood pressure response to exercise. Ann Intern Med. 1990. 112:161–166.
11. Sharabi Y, Ben-Cnaan R, Hanin A, Martonovitch G, Grossman E. The significance of hypertensive response to exercise as a predictor of hypertension and cardiovascular disease. J Hum Hypertens. 2001. 15:353–356.
12. Doo YC, Cho BD, Han TH, et al. Prognostic values of symptom-limited exercise test early after acute myocardial infarction. Korean Circ J. 1996. 26:787–793.
13. Mark DB, Shaw L, Harrell FE Jr, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991. 325:849–853.
14. Wilson MF, Sung BH, Pincomb GA, Lovallo WR. Exaggerated pressure response to exercise in men at risk for systemic hypertension. Am J Cardiol. 1990. 66:731–736.
15. Goble MM, Schieken RM. Blood pressure response to exercise: a marker for future hypertension? Am J Hypertens. 1991. 4:617S–620S.
16. Dlin RA, Hanne N, Silverberg DS, Bar-Or O. Follow-up of normotensive men with exaggerated blood pressure response to exercise. Am Heart J. 1983. 106:316–320.
17. Manolio TA, Burke GL, Savage PJ, Sidney S, Gardin JM, Oberman A. Exercise blood pressure response and 5-year risk of elevated blood pressure in a cohort of young adults. Am J Hypertens. 1994. 7:234–241.
18. Matthews CE, Pate RR, Jackson KL, et al. Exaggerated blood pressure response to dynamic exercise and risk of future hypertension. J Clin Epidemiol. 1998. 51:29–35.
19. Chaney RH, Eyman RK. Blood pressure at rest and during maximal dynamic and isometric exercise as predictors of systemic hypertension. Am J Cardiol. 1988. 62:1058–1061.
20. Tanji JL, Champlin JJ, Wong GY, Lew EY, Brown TC, Amsterdam EA. Blood pressure recovery curves after submaximal exercise: a predictor of hypertension at ten-year follow-up. Am J Hypertens. 1989. 2:135–138.
21. Lauer MS, Levy D, Anderson KM, Plehn JF. Is there relationship between exercise systolic blood pressure response and left ventricular mass? Ann Intern Med. 1992. 116:203–210.
22. Ilia R, Carmel S, Tsatskis B, Gueron M. Exaggerated blood pressure response at exercise in normotensive subjects: demographic and stress performance characteristics. Am Heart J. 1998. 136:499–503.
23. Allison TG, Cordeiro MA, Miller TD, Daida H, Squires RW, Gau TG. Prognostic significance of exercise-induced systemic hypertension in healthy subjects. Am J Cardiol. 1999. 83:371–375.
24. Singh JP, Larson MG, Manolio TA, et al. Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. Circulation. 1999. 99:1831–1836.
25. Ahn SJ, Sung J, Kim PH, et al. Correlation between vascular compliance and increase of blood pressure on exercising in normotensive group. Korean Circ J. 2004. 34:784–788.
26. Kohl HW 3rd, Nichaman MZ, Frankowski RF, Blair SN. Maximal exercise hemodynamics and risk of mortality in apparently healthy men and women. Med Sci Sports Exerc. 1996. 28:601–609.
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