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CLINICAL STUDY: HYPERTENSION

Hypertensive response to exercise: a potential cause for new wall motion abnormality in the absence of coronary artery disease

Jong-Won Ha, MD, PhD^*, Eldyn M. Juracan, MD^*, Douglas W. Mahoney, MS, Jae K. Oh, MD, FACC^*, Clarence Shub, MD, FACC^*, James B. Seward, MD, FACC^* and Patricia A. Pellikka, MD, FACC^*,*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received May 10, 2001; revised manuscript received October 10, 2001, accepted October 26, 2001.

^* Reprint requests and correspondence: Dr. Patricia A. Pellikka, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 USA.
pellikka.patricia{at}mayo.edu

OBJECTIVES: We sought to characterize patients with a hypertensive response during exercise echocardiography and its effect on results of the test.

BACKGROUND: A hypertensive response to exercise has been shown to cause false-positive results in perfusion imaging, radionuclide angiography and exercise electrocardiography, but its influence on exercise echocardiography has not been reported.

METHODS: We identified 548 of 6,686 patients who had coronary angiography within four weeks after exercise echocardiography from 1992 through 1996. Echocardiographic results from 132 patients (24%) with a hypertensive response to exercise, defined as systolic blood pressure (SBP) >220 mm Hg for men and SBP >190 mm Hg for women or as an increase in diastolic blood pressure (DBP) >10 mm Hg or DBP >90 mm Hg during exercise echocardiography, were compared with those from 416 patients without a hypertensive response.

RESULTS: Of 132 patients with a hypertensive response to exercise, 108 patients had exercise echocardiographic results positive for ischemia. Of these patients, 24 (22%) were found to have no significant coronary artery disease (CAD). In contrast, of 320 patients with positive exercise echocardiographic results without a hypertensive response, 39 (12%) patients did not have significant CAD. Among the false-positive results, new wall motion abnormalities were extensive in 15 of 24 (63%) hypertensive responders involving >25% of segments compared with 14 of 39 nonhypertensive responders (36%, p = 0.012).

CONCLUSIONS: An excessive rise in blood pressure during exercise is associated with a greater likelihood of new or worsening abnormalities with exercise, which may be observed in the absence of angiographically significant coronary artery stenosis.

Abbreviations and Acronyms   CAD   coronary artery disease   DBP   diastolic blood pressure   LV   left ventricular   SBP   systolic blood pressure

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