Delayed systolic blood pressure recovery after graded exercise - An independent correlate of angiographic coronary disease

OBJECTIVE This study was performed to determine whether a delayed decline i n systolic blood pressure (SBP) after graded exercise is an independent cor relate of angiographic coronary disease. BACKGROUND The predictive importance of the rate of SBP decline after exerc ise relative to blood pressure changes during exercise has not been well ex plored. METHODS Among adults who underwent symptom-limited exercise treadmill testi ng and who underwent coronary angiography within 90 days, a delayed decline in SBP during recovery was defined as a ratio of SBPs at 3 min of recovery to SBP at 1 min of recovery >1.0. Severe angiographic coronary artery dise ase was defined as left main disease, three-vessel disease or two-vessel di sease with involvement of the proximal left anterior descending artery. RESULTS There were 493 subjects eligible for analyses (age 59 +/- 11 years, 78% male). Severe angiographic coronary disease was noted in 102 (21%). Th ere were associations noted between a delayed decline in SEP during recover y and severe angiographic coronary disease (34% vs. 17%, odds ratio [OR] 2. 59, confidence interval [CI] 1.58 to 4.25, p = 0.001). In multivariate logi stic regression analyses adjusting for SEP changes during exercise and othe r potential confounders, a delayed decline in SBP during recovery remained predictive of severe angiographic coronary disease (adjusted OR 2.22, 95% C I 1.27 to 3.87, p = 0.005). CONCLUSIONS delayed decline in SEP during recovery is associated with a gre ater likelihood of severe angiographic coronary disease even after accounti ng for the change in SBP during exercise. (J Am Coll Cardiol 1999;34:754-9) (C) 1999 by the American College of Cardiology.