Exaggerated exercise blood pressure response and risk of stroke in patients referred for stress testing

Excessive blood pressure increase with exercise and risk of all‐cause mortality and cardiac events

“…A total of 13 328 adult patients with known or suspected CAD who underwent treadmill exercise echocardiography at our hospital were initially considered for inclusion. Exclusion criteria have been described elsewhere . Briefly, we excluded 1113 patients who did not belong to the geographic area of reference of our hospital, 1218 patients who had received beta‐blockers within 48 h before testing and 950 patients whose SBP during exercise did not exceed the pre‐exercise value .…”

“…≥ 80 mmHg). Given that the degree of increase in SBP during exercise may depend on exercise capacity, we also estimated the ratio of the increase in SBP during exercise to exercise workload in METs (ΔSBPeEW) and defined an EBPIE standardized for exercise workload (EBPIESEW) as an ΔSBPeEW higher than or equal to the 95th percentile value in our study sample (i.e. ≥ 10 mmHg/MET).…”

Exercise systolic blood pressure at moderate workload predicts cardiovascular disease and mortality through 35 years of follow-up in healthy, middle-aged men

“…showed that a steep increase in systolic blood pressure at moderate workload was associated with stroke risk in healthy participants, but they were not able to show increased risk of stroke based on maximal systolic blood pressure during exercise (83). Bouzas-Mosquera et al found no relationship between exercise systolic blood pressure and risk of stroke, whether maximal systolic blood pressure or the increase in systolic blood pressure between resting and maximal effort during exercise, in patients with known or suspected coronary disease (84). However, exercise blood pressure and risk of stroke have not been evaluated in a truly healthy cohort, and the previous findings may propose different aetiology behind hypertension-mediated coronary disease and stroke.…”

“…treadmill or bicycle, and different populations regarding age, sex and ethnicities (80,81,117). Studies have also included healthy participants (78,83,97,98), hypertensive participants (93,95,96) and participants with known or suspected coronary disease (84,118).…”

Novelties on Stress Echocardiography for the Assessment of Ischemia

“…In a wide research of our institution including more than 10,000 patients we have found that an excessive blood pressure increase with exercise (i.e., an increase in systolic blood pressure with exercise ≥ 80 mmHg) was associated with better outcomes in patients with known or suspected CAD referred for ExE, after adjustment for other potential confounders [33]. Patients with an excessive blood pressure increase were less likely to have abnormal ExE results, and had a significantly lower risk of mortality and major cardiac events [33] without evidence of an increase in their risk of stroke [34].…”