Supine and exercise systolic blood pressure predict cardiovascular death in middle-aged men

Aim and methods The outcome of 1999 apparently healthy men, aged 40-59 year s, initially investigated in the period 1972-1975, has previously been asce rtained at 7 and 16 year follow-ups. This has now been repeated after 21 ye ars, to determine whether seated systolic blood pressure (BP) during a bicy cle ergometer exercise test adds prognostic information on cardiovascular ( CV) mortality beyond that of systolic BP measured after 5 min of supine res t. Results After 21 years, 41 979 years of observation, 470 patients had died, 255 from CV causes. Supine systolic BP [2 SD increase: relative risk (RR) 1.6, 95% confidence interval (CI) 1.3-2.0, P < 0.0001], 6 min exercise syst olic BP (2 SD increase: RR 1.6, 95% CI 1.3-2.0, P < 0.0001) on the starting workload of 600 kpm/min (approximate to 100 W, 5880 J/min) and maximal sys tolic BP (2 SD increase: RR 1.5, 95% CI 1.2-1.9, P = 0.0005) during work we re all related to CV mortality when adjusting for a large number of variabl es measured in the present study including age, exercise capacity, heart ra tes, smoking habits, glucose tolerance and serum cholesterol. When includin g other systolic Bps in the continuous multivariate analysis, supine systol ic BP (2 SD increase: RR 1.4, 95% CI 1.04-1.9, P = 0.029) and 6 min systoli c BP at 600 kpm/min (2 SD increase: RR 1.4,95% CI 1.06-1.9, P = 0.017) were independent predictors of CV death but not maximal systolic BP during exer cise (2 SD increase: RR 1.0, 95% CI 0.7-1.2, P = 0.95). Conclusion These results are different from the mortality data at 16 years, when the independent predictive effect of supine systolic BP was cancelled out by 6 min exercise systolic BP at 600 kpm/min. Twenty-one years of foll ow-up of 1999 apparently healthy men disclose independently predictive info rmation on CV death, of both supine systolic BP and 6 min exercise systolic BP taken at an early moderate workload. The influence of maximal exercise systolic BP on CV death is however cancelled out by the two other systolic Bps. (C) 2001 Lippincott Williams & Wilkins.