ANGIOGRAPHIC AND PROGNOSTIC IMPLICATIONS OF AN EXAGGERATED EXERCISE SYSTOLIC BLOOD-PRESSURE RESPONSE AND REST SYSTOLIC BLOOD-PRESSURE IN ADULTS UNDERGOING EVALUATION FOR SUSPECTED CORONARY-ARTERY DISEASE

Objectives. This study was designed to assess the angiographic and pro gnostic implications of an exaggerated systolic blood pressure respons e to exercise (''exercise hypertension'') in adults undergoing evaluat ion for suspected coronary artery disease. Background. The clinical im plications of exercise hypertension are unclear. Methods. Subjects for this prospective cohort study were derived from a consecutive sample of 9,608 adults who were referred for treadmill testing and who augmen ted their systolic blood pressure by at least 10 mm Hg. There were 594 subjects who underwent coronary angiography within 90 days of treadmi ll testing. Exercise hypertension was defined as a peak exercise systo lic blood pressure greater than or equal to 210 mm Hg in men and great er than or equal to 190 mm Hg in women. Severe angiographic coronary d isease was defined as left main coronary artery disease (greater than or equal to 50% diameter stenosis), three-vessel disease (greater than or equal to 70% diameter stenosis) or two-vessel disease with greater than or equal to 70% diameter stenosis of the proximal left anterior descending coronary artery. All-cause mortality was assessed during a follow-up period of similar to 2 years. Results. Exercise hypertension was present in 196 subjects (33%). Severe coronary disease was less c ommon in subjects with exercise hypertension (14% vs. 25%, odds ratio 0.51, 95% confidence interval [CI] 0.32 to 0.81, p = 0.004). Exercise hypertension remained associated with a lower rate of severe coronary disease even after adjusting for rest hypertension, age, gender, exerc ise capacity and other possible confounders. During the follow-up peri od, there were 23 deaths; only 2 occurred in the group with exercise h ypertension. After adjusting for severity of coronary disease, exercis e hypertension remained associated with a lower mortality rate (adjust ed relative risk 0.20, 95% CI 0.05 to 0.84, p = 0.03). Conclusions. In adults evaluated for coronary artery disease, exercise hypertension i s associated with a lower likelihood of angiographically severe diseas e and a lower adjusted mortality rate. (J Am Coll Cardiol 1995;26:1630 -6)