Exercise Blood Pressure Predicts Mortality From Myocardial Infarction

Abstract

Apparently healthy men (n=1999, 40 to 59 years old) were investigated from 1972 through 1975 to determine whether systolic blood pressure during bicycle ergometer exercise predicts morbidity and mortality from myocardial infarction beyond that of casual blood pressure taken after 5 minutes of supine rest. During a follow-up of 31 984 patient-years (average, 16 years), 235 subjects had myocardial infarctions, of which 143 were nonfatal and 92 were fatal. Exercise blood pressure was more strongly related than casual blood pressure to both morbidity and mortality from myocardial infarction. Among 520 men with casual systolic blood pressure = 140 mm Hg, 304 increased their systolic blood pressure to > or = 200 mm Hg during 6 minutes of exercise at an initial workload of 600 kpm/min. These 304 men had an excessive risk of myocardial infarction (18.8% versus 9.5% among the 1294 men with casual blood pressure < 140 mm Hg and exercise blood pressure < 200 mm Hg; P < .001). As many as 58% of those with myocardial infarction in this group died, compared with 33% (range, 26% to 35%) for all other groups (P=.0011), including those with casual blood pressure > or = 140 mm Hg and exercise blood pressure < 200 mm Hg. Thus, exercise blood pressure is a stronger predictor than casual blood pressure of morbidity and mortality from myocardial infarction, and an early rise in systolic blood pressure during exercise adds prognostic information about mortality from myocardial infarction among otherwise healthy middle-aged men with mildly elevated casual blood pressure. We suggest that blood pressure taken during standardized exercise testing may distinguish between severe and less severe hypertension.

Insulin Sensitivity Is Related to Physical Fitness and Exercise Blood Pressure to Structural Vascular Properties in Young Men

“…8 Systolic BP (SBP), taken after 6 minutes on the first load of 600 kilo/pound/meter [kpm] per min (Ϸ100 W) during an ergometer bicycle exercise test in middle-aged healthy Norwegian men, 9 was a strong independent risk factor for cardiovascular death 12 and death from myocardial infarction. 13 In fact, the predictive power of SBP after 6 minutes of exercise was so strong that the predictive value of casual BP became nonsignificant when the two values were analyzed together. On the basis of hemodynamic studies of Folkow,14 who found increased peripheral resistance in structurally altered hypertensive vessels, Mundal et al 13 hypothesized that a sudden rise in SBP during exercise was caused by a failure to reduce total peripheral resistance during exercise, ie, that SBP during exercise may be a marker for structural vascular changes.…”

“…13 In fact, the predictive power of SBP after 6 minutes of exercise was so strong that the predictive value of casual BP became nonsignificant when the two values were analyzed together. On the basis of hemodynamic studies of Folkow,14 who found increased peripheral resistance in structurally altered hypertensive vessels, Mundal et al 13 hypothesized that a sudden rise in SBP during exercise was caused by a failure to reduce total peripheral resistance during exercise, ie, that SBP during exercise may be a marker for structural vascular changes. Therefore, the second aim of the present study was to investigate a possible association between exercise BP taken as SBP after 6 minutes of exercise at 600 kpm/min and peripheral vascular structure assessed by MFVR in the young men and also to relate exercise SBP after 6 minutes to other BP values.…”

Blood pressure determinants of left ventricular wall thickness and mass index in hypertension: comparing office, ambulatory and exercise blood pressures

“…36 We have previously reported that up to a third of treated hypertensives with 'controlled' OBP continue to exhibit uncontrolled levels of BP during a 3-min step test. 37 Indeed, the prognostic value of the submaximal ExSBP as a better predictor of cardiac death than OBP has been confirmed in a few large retrospective studies, [38][39][40] and a prospective study is currently on-going. 41 Furthermore, the ExSBP is a better marker than OBP in defining sustained hypertension 42 and we have also recently reported that apparently healthy hypertensives with a raised ExSBP had prolonged maximum heart rate corrected QT interval independent of LV mass.…”

Low‐grade systolic murmurs in healthy middle‐aged individuals: innocent or clinically significant? A 35‐year follow‐up study of 2014 Norwegian men

“…Individuals were included if, after scrutiny of their company health records, they were found to be healthy and free from a number of diseases ⁄ conditions including known or suspected CVD, diabetes mellitus, cancer and advanced pulmonary, liver or renal diseases [6]. Subjects receiving treatment with any chronic drug regimens were also excluded, as were those who were judged to be unable to perform a symptom-limited bicycle exercise test for orthopaedic, muscular or neurological reasons [8]. Subjects with self-reported diagnoses of any of the afore-mentioned conditions since last visiting their company physician were examined, but excluded from our data file.…”

“…Blood pressure was measured in the recumbent position after resting for 5 min, and heart and respiratory rates were measured for 1 min. At heart auscultation, both the bell and membrane of the stethoscope were applied with the participants sitting, lying on their back and in the left lateral recumbent position [8]. Auscultation was performed during quiet respiration and during breath holding in inspiration and expiration.…”