PROGNOSTIC VALUE OF INVASIVE HEMODYNAMIC MEASUREMENTS AT REST AND DURING EXERCISE IN HYPERTENSIVE MEN

In 1994, we ascertained the outcome of 143 hypertensive men in whom in vasive hemodynamic measurements were performed at rest and during grad ed bicycle exercise during the period 1972-1982 to assess (1) which of the hemodynamic components of blood pressure is associated with the i ncidence of cardiovascular events and total mortality, and (2) whether the hemodynamic response to dynamic exercise adds prognostic precisio n to the data at rest. During 2186 patient years of follow-up, 38 pati ents suffered at least one fatal or nonfatal cardiovascular event and 17 patients died. Cox regression analysis showed that systolic pressur e and systemic vascular resistance measured at rest, during submaximal exercise (50 W), and at peak effort were significant (P<.01) predicto rs of the age-adjusted incidence of cardiovascular events and total mo rtality. However, exercise blood pressure did not significantly predic t the incidence of cardiovascular events over and above pressure at re st; by contrast, exercise systemic vascular resistance added prognosti c precision to vascular resistance at rest (P<.01). As for total morta lity, systolic pressure and systemic vascular resistance at peak exerc ise carried prognostic information that was independent of the results at rest (P<.05); this was not the case for measurements during submax imal exercise. We conclude that the prognostic importance of blood pre ssure is related to systemic vascular resistance. The prognostic preci sion of exercise pressure, on top of pressure at rest, is limited. Exe rcise systemic vascular resistance, however, provides prognostic infor mation beyond that available from measurements at rest, particularly f or the incidence of cardiovascular events.