Prognostic significance of exercise-induced systemic hypertension in healthy subjects

Exercise hypertension has been suggested to predict future resting hyperten sion, but its significance in terms of cardiovascular risk has not been def ined. To assess the prognostic significance of exercise hypertension, 150 h ealthy, asymptomatic subjects with normal resting blood pressures and exerc ise systolic blood pressures greater than or equal to 214 mm Hg (i.e., >90t h percentile) on Bruce treadmill tests were identified retrospectively and age- and gender-matched with subjects with exercise systolic blood pressure s of 170 to 192 mm Hg (40th to 70th percentiles). Subjects were contacted b y survey a mean of 7.7 +/- 2.9 years after the index treadmill test. The su rvey response rate was 93%. There were 12 deaths, including 8 in the exerci se hypertension group. A major cardiovascular event, defined as cardiovascu lar death, myocardial infarction, stroke, coronary angioplasty, or coronary bypass graft surgery occurred in 5 controls and 10 subjects with exercise hypertension. At follow-up, 13 controls and 37 subjects with exercise hyper tension were now diagnosed as having resting hypertension. In multivariate analysis, exercise hypertension was not a significant predictor for death o r any individual cardiovascular event, but was for total cardiovascular eve nts and new resting hypertension. The multivariate risk ratio for exercise hypertension was 3.62 (p = 0.03) in predicting a major cardiovascular event . Other significant predictors included body mass index and age. For predic ting new resting hypertension, the multivariate odds ratio for exercise hyp ertension was 2.41 (p = 0.02). These data suggest that exercise hypertensio n carries a small but significant risk for major cardiovascular events in h ealthy, asymptomatic persons with normal resting blood pressures. (C)1999 b y Excerpta Medico, Inc.