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CLINICAL STUDIES

Delayed systolic blood pressure recovery after graded exercise

An independent correlate of angiographic coronary disease

^a George M. and Linda H. Kauffman Center for Heart Failure, Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received December 21, 1998; revised manuscript received March 25, 1999, accepted May 16, 1999.

Reprint requests and correspondence: Michael S. Lauer, Section of Heart Failure and Cardiac Transplantation Medicine, Department of Cardiology, Desk F-25, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.
lauerm{at}cesmtp.ccf.org

OBJECTIVE

This study was performed to determine whether a delayed decline in systolic blood pressure (SBP) after graded exercise is an independent correlate of angiographic coronary disease.

BACKGROUND

The predictive importance of the rate of SBP decline after exercise relative to blood pressure changes during exercise has not been well explored.

METHODS

Among adults who underwent symptom-limited exercise treadmill testing 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 disease was defined as left main disease, three-vessel disease or two-vessel disease 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%). There were associations noted between a delayed decline in SBP during recovery 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 logistic regression analyses adjusting for SBP changes during exercise and other potential confounders, a delayed decline in SBP during recovery remained predictive of severe angiographic coronary disease (adjusted OR 2.22, 95% CI 1.27 to 3.87, p = 0.005).

CONCLUSIONS

A delayed decline in SBP during recovery is associated with a greater likelihood of severe angiographic coronary disease even after accounting for the change in SBP during exercise.

Abbreviations and Acronyms   CAD = coronary artery disease   CI = confidence interval   METs = metabolic equivalents   OR = odds ratio   SBP = systolic blood pressure

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