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Elevated exercise BP nonsignificant for CVD–related death after accounting for rest BP

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For asymptomatic individuals, elevated exercise BP was associated with a higher risk for CVD–related mortality but was statistically nonsignificant after accounting for rest BP, study findings suggested.

In a population of 6,578 asymptomatic participants from the Lipid Research Clinics Prevalence Study, researchers from several U.S. sites evaluated whether exaggerated systolic or diastolic BP attained at low and submaximal exercise was linked to future CVD death risk. A comprehensive medical history, physical exam, fasting blood samples, resting electrocardiogram and exercise treadmill test were obtained at baseline.

Participants were ineligible if they were pregnant; had evidence of current or past myocardial ischemia or coronary artery bypass surgery; had baseline systolic BP <90 mm Hg or >200 mm Hg or diastolic BP >120 mm Hg; or were deemed ineligible for exercise testing.

During the 20-year follow-up, 385 CVD deaths occurred. Overall, systolic and diastolic BP at rest, Bruce stage 2 and maximal exercise were significantly associated with higher CVD death. When the researchers compared multivariate HRs and 95% CIs per 10/5-mm Hg BP increments, the association was strongest for BP at rest (systolic, HR=1.21; diastolic, HR=1.20), followed by Bruce stage 2 (systolic, HR=1.09; diastolic, HR=1.09) and maximal exercise (systolic, HR=1.06; diastolic, HR=1.04). However, exercise-related BP, regardless of workload, was not significant after accounting for rest BP in the overall population.

The researchers did note that baseline hypertension status modified the risk associated with exercise BP. “Specifically, among nonhypertensives with either normal BP or prehypertension at rest, elevated exercise BP at Bruce stage 2 >180 mm Hg/90 mm Hg identified individuals with up to 2.4-fold higher risk for future CVD death and added predictive value to rest BP and risk factors, possibly warranting more aggressive treatment than is currently recommended,” they wrote.

Weiss SA. Circulation. 2010;121:2109-2116.

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