ABNORMAL SYSTOLIC BLOOD-PRESSURE RESPONSE DURING EXERCISE RECOVERY INPATIENTS WITH ANGINA-PECTORIS

Objectives. This study was conducted to clarify the mechanisms of the abnormal systolic blood pressure response after exercise in patients w ith angina pectoris. Background. An abnormal systolic blood pressure r esponse in patients with angina pectoris has been observed not only du ring exercise but also during the recovery period after exercise. Howe ver, the mechanisms of this abnormal response during recovery have not been elucidated. Methods. Thirty-five patients with angina pectoris a nd 17 control subjects underwent bicycle ergometric studies after inse rtion of a Swan-Ganz catheter. Results. In control subjects, all hemod ynamic variables decreased rapidly after exercise. In 7 of the 35 pati ents, systolic blood pressure increased after exercise. The patients w ith angina were classified into two groups. In group I (17 patients), changes in systolic blood pressure during recovery were smaller than t hose in control subjects. In group II (18 patients) recovery of systol ic blood pressure was normal. Changes in stroke index from rest to pea k exercise were smaller in group I than in group II. Stroke index in b oth patient groups increased paradoxically during recovery. The increa se in systemic vascular resistance index during recovery and the ratio of plasma norepinephrine concentration to cumulative work toad were g reater in group I than in group II. Conclusions. An abnormal systolic blood pressure response after physical exercise in patients with angin a pectoris is indicative of severe myocardial ischemia during exercise and may be caused by an increase in stroke volume due to recovery fro m myocardial ischemia and increased systemic vascular resistance secon dary to exaggerated sympathetic nervous activity.