248 Association between abnormal blood pressure response to exercise and incident cardiovascular events

Abstract

Objective. The aim of this multicentre registry was to verify the association between an exaggerated blood pressure response (EBPR) to exercise stress test (EST) and evidence of previous myocardial and/or brain ischemic events in the general population. Methods. All subjects who underwent EST for screening of ischemic heart disease and/or follow-up and re-evaluation of heart disease were included in the registry. Patients who discontinued EST due to early muscle exhaustion, younger individuals (<18 years), patients with potentially dangerous channelopathies or ventricular arrhythmias, as well as those with disabling chronic diseases or experiencing cardiovascular events in the 3 months prior to TE. Everyone performed EST on a treadmill or cycle ergometer using similar protocols in the various centres. Based on some study in the literature, we identified the EBPR to exercise for a systolic BP rise >60 mmHg (men) or >50 mmHg (women) compared to pre-exercise baseline measurement, but also an absolute value >210 or >190 mmHg, respectively. Retrospectively, we verified the presence of non-disabling ischemic cardiac and cerebrovascular events over the past 10 years. Results. 503 subjects of mean age 61+/-11 years were included in the registry. EST was performed on a treadmill in 65% of subjects and maximal workload was achieved by 75% of them. Subjects with EBPR were 170 (34%) vs 333 (66%) who had normal response (controls). EBPR group included most male subjects, often overweight and with a higher prevalence of diabetes (31% vs 20% in the control group, p <0.01), and with already diagnosed arterial hypertension in a half of cases. Previous ischemic myocardial events were found in 35% of EBPR subjects vs 36% of controls (p=NS), while cerebrovascular disease in 20% vs 10%, respectively (p <0.005). Conclusions. Albeit retrospectively performed, this multicentre registry highlighted an association between EBPR to exercise (present in more than one third of the subjects examined, especially males) and history of cerebrovascular ischemic events within 10 years prior to enrolment. In line with previous studies, present data confirmed a clinical impact of EBPR on exercise. However, the precise pathophysiological mechanism(s) need to be clarified yet, also in terms of therapies against such exaggerated functional response and its possible prognostic impact over time.