Ellis Keith, Pothier Claire E, Blackstone Eugene H, Lauer Michael S
Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Am Heart J. 2004 Feb;147(2):287-92. doi: 10.1016/j.ahj.2003.08.009.
An attenuated systolic blood pressure recovery after exercise has been associated with the severity of atherosclerotic heart disease.
For 6 years, we observed 12,379 patients who underwent symptom-limited exercise testing. We excluded patients receiving antihypertensive medication and patients with valvular disease, emphysema, end-stage renal disease, heart failure, left ventricular systolic dysfunction, and atrial fibrillation. Blood pressure recovery ratio was defined as the ratio of systolic blood pressure at 3 minutes into recovery to systolic blood pressure at peak exercise; this has been shown to correlate with angiographic severity of coronary disease.
The blood pressure recovery ratios ranged from 0.36 to 1.62, with values for increasing quartiles of 0.72 +/- 0.05, 0.82 +/- 0.02, 0.88 +/- 0.02, and 0.99 +/- 0.07. During follow-up, there were 430 deaths (3%). Five-year Kaplan Meier survival rates were 0.975, 0.974, 0.969, and 0.966 in quartiles 1 to 4, respectively. Compared with patients in the lowest quartile of blood pressure recovery ratio, patients in the highest quartile were at somewhat increased risk (hazard ratio, 1.71; 95% CI, 1.31-2.24; P <.001). However, after adjusting for age, sex, body mass index, resting heart rate and blood pressure, peak systolic blood pressure, heart rate recovery, exercise chronotropic response, cardiac history, and standard risk factors, this association was no longer present (adjusted hazard ratio, 1.05; 95% CI, 0.8-1.38; P =.74).
In this low-risk population, abnormal systolic blood pressure recovery after exercise was not independently predictive of mortality after correcting for differences in baseline and exercise characteristics.
运动后收缩压恢复减弱与动脉粥样硬化性心脏病的严重程度相关。
6年间，我们观察了12379例接受症状限制性运动试验的患者。我们排除了正在接受抗高血压药物治疗的患者以及患有瓣膜病、肺气肿、终末期肾病、心力衰竭、左心室收缩功能障碍和心房颤动的患者。血压恢复率定义为恢复3分钟时的收缩压与运动峰值时的收缩压之比；这已被证明与冠状动脉疾病的血管造影严重程度相关。
血压恢复率范围为0.36至1.62，四分位数增加值分别为0.72±0.05、0.82±0.02、0.88±0.02和0.99±0.07。随访期间，有430例死亡（3%）。四分位数1至4的五年Kaplan Meier生存率分别为0.975、0.974、0.969和0.966。与血压恢复率最低四分位数的患者相比，最高四分位数的患者风险略有增加（风险比，1.71；95%可信区间，1.31 - 2.24；P <.001）。然而，在调整年龄、性别、体重指数、静息心率和血压、收缩压峰值、心率恢复、运动变时反应、心脏病史和标准危险因素后，这种关联不再存在（调整后风险比，1.05；95%可信区间，0.8 - 1.38；P =.74）。
在这个低风险人群中，校正基线和运动特征差异后，运动后异常的收缩压恢复并不能独立预测死亡率。
