Usefulness of the postexercise response of systolic blood pressure in the diagnosis of coronary artery disease.

Abstract

The normal decline in systolic blood pressure (SBP) during the recovery phase of treadmill exercise does not occur in some patients with coronary artery disease (CAD). In others the recovery values of SBP exceed the peak exercise values. To examine the diagnostic value of this observation, we studied 31 normal subjects and 56 patients undergoing treadmill exercise before coronary cineangiography. Because of large differences in peak exercise pressures between the two groups, recovery ratios were derived by dividing the SBP at 1, 2, and 3 min after exercise by the peak exercise SBP. The 1, 2, and 3 min ratios in the normal subjects declined steadily from 0.85 0.07 (SD) to 0.79 + 0.06 and to 0.73 0.06, respectively, while the ratios in the patients with CAD remained elevated at 0.97 + 0.12 to 0.97 0.11 to 0.93 0.13. With use of the upper limits defined by two SDs of the normal value, recovery ratios were compared with the occurrence of angina and with ST segment depression on the exercise electrocardiogram in the patients with CAD. Abnormal ratios were more frequent in patients with CAD (53/56, 95%) than in those with ST segment depression (33/56, 59%), angina (37/56, 66%), and either ST segment depression or angina (42/56, 75%). Twenty of the patients with CAD who were on no medication underwent an additional treadmill exercise test on a separate day and no significant differences were found in the ratios from the two tests. Ten additional patients with CAD underwent treadmill exercise testing while on placebo and while on a fl-blocker. There were no significant differences in the ratios from the two tests. Twenty-eight of the 31 (90%) normal subjects had normal recovery ratios. We conclude that the ratios of early recovery SBP to the peak exercise SBP are more sensitive than exercise electrocardiographic changes and angina for identifying patients with CAD. Circulation 70, No. 6, 951-956, 1984. SINCE the original descriptions of electrocardiographic (ECG) changes during angina pectoris, la 2 numerous investigations have been conducted to assess the feasibility of increasing the sensitivity and specificity of the ECG for detecting ischemic heart disease.

Twenty-four hour blood pressure after exercise in patients with coronary artery disease

“…24 Furthermore the results in patients with coronary heart disease may differ from those of other subjects because of their medical treatment and because postexercise blood pressure appears to be influenced by the extent of coronary heart disease and of the possible exercise-induced impairment of left ventricular function. [15][16][17][18][19][20] The lower blood pressure on standing on the exercise day compared to the control day is compatible with the observation that orthostatic tolerance is impaired during the first half hour of recovery after exercise. 3 The results on subsequent ambulatory monitoring agree with those in healthy normotensive subjects, in whom ambulatory 10,12,14 or home 11 measurements of blood pressure showed that any blood pressure fall immediately after exercise was not sustained during the rest of the day.…”

“…[10][11][12]14 Similar results have been obtained in hypertensives, 11,13 but other studies 10,12,14 observed that hypotension was sustained for about 5 to 13 h after exercise. Studies in coronary artery disease concentrated on blood pressure measured during 3 to 5 min after exercise testing in order to improve the detection of ischaemia or to assess disease severity, [15][16][17][18][19][20] but we found no studies on the effect of a single bout of aerobic exercise or rehabilitation exercise training on blood pressure during longer periods of time and certainly not for 24 h after exercise in patients with coronary artery disease. An increasing number of cardiac patients are participating in rehabilitation programmes, in which the exercise intensity may be rather high.…”

Systolic Blood Pressure During Recovery From Exercise and the Risk of Acute Myocardial Infarction in Middle-Aged Men

“…It has been suggested previously that abnormal SBP response is an important indicator for coronary artery disease not only during exercise but also during the recovery phase. 14,24,25 Some studies observed that an abnormal ratio of recovery to peak exercise was even more sensitive than exercise-induced angina or ST depression for diagnosing the †Pack years denotes the lifelong exposure to smoking that was estimated as the product of years smoked and the number of tobacco products smoked daily at the time of examination. ‡Diabetes was defined as fasting blood glucose Ն6.1 mmol/L or a clinical diagnosis of diabetes with dietary, oral, or insulin treatment.…”

“…severity of coronary artery disease. 24,25 In patients with angina pectoris, an abnormal SBP response during recovery was very sensitive for the diagnosis of multivessel coronary artery disease, suggesting the close correlation between this response and the severity of CHD. 14 Elevated SBP response during the exercise anticipation phase and attenuated SBP responses after exercise were related to increased risk of hypertension 6,21 and stroke.…”

Short-term effects of treadmill exercise on metabolic, physiological and hemodynamic functions of apparently healthy individuals.

“…This observation is in collaboration with the study carried out by Davis and Brown, 2001 18 . Amon et al, (1984) 19 in their study reported that during treadmill exercise in the normal subjects, systolic blood pressure is expected to rise to between 5 to 10 mmHg per metabolic equivalent of effort. A decrease in the diastolic blood pressure was recorded in this study and this could be attributed to the vasodilatation of arterial blood vessels in response to the exercise bouts.…”