Yosefy Chaim, Jafari Jamal, Klainman Eliezer, Brodkin Boris, Handschumacher Mark D, Vaturi Mordehay
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, 55 Fruit St., VBK 508, Harvard Medical School, Boston, MA, USA.
Int J Cardiol. 2006 Aug 28;111(3):352-7. doi: 10.1016/j.ijcard.2005.07.039. Epub 2005 Oct 18.
Hypertensive response at peak-exercise and during the recovery phase of exercise stress test (ET) is associated with poor cardiovascular prognosis. We investigated whether decrease in blood pressure (BP) from peak to post-exercise would identify a subgroup at higher cardiovascular risk.
Eighty-six non-hypertensive patients (0-4 cardiovascular risk factors) with hypertensive reaction at peak-ET (systolic>180 mm Hg and/or diastolic>100 mm Hg) were divided based on BP 5 min after exercise termination into two groups: Normal response (NrmR) (<160/90 mm Hg), Hypertensive response (HypR) (>/=160/90 mm Hg). Five years later the prevalence of cardiovascular risk factors and cardiovascular morbidity and mortality was assessed for each group.
Both groups had similar pre- and peak-exercise BP. However the HypR group had higher post-exercise BP (systolic: 163+/-13 vs. 125+/-14 mm Hg, respectively, p<0.01, and diastolic: 74+/-6 vs. 75+/-4 mm Hg, respectively, p<0.01), smaller decrease in BP after exercise (Delta systolic: 46.9+/-3.1 vs. 73.9+/-3.6 mm Hg, respectively, p<0.01, Delta diastolic: 12.4+/-1.5 vs. 26.5+/-2.2 mm Hg, respectively, p<0.01), and higher post- than pre-exercise BP (Delta systolic: 24.5+/-3.5 vs. -6+/-4.1 mm Hg, respectively, p<0.01, A diastolic: 19+/-2.1 vs. -13+/-2.3 mm Hg, respectively, p<0.01). Five years later, HypR group had higher prevalence of abnormal cholesterol serum level (p<0.01), hypertension (p<0.01) and combined ischemic heart disease and cerebrovascular disease (RR 1.32, 95% CI=1.13-1.54, p<0.01).
During ET evaluation, it is important to evaluate the BP at 5 min after exercise because reduced BP drop, at this routinely measured point, identifies a subgroup with higher cardiovascular risk.
运动应激试验（ET）峰值运动时和恢复阶段的高血压反应与不良心血管预后相关。我们研究了运动后血压从峰值到运动后下降是否能识别出心血管风险较高的亚组。
86例运动应激试验峰值时出现高血压反应（收缩压>180 mmHg和/或舒张压>100 mmHg）的非高血压患者（0 - 4个心血管危险因素），根据运动结束后5分钟的血压分为两组：正常反应组（NrmR）（<160/90 mmHg），高血压反应组（HypR）（≥160/90 mmHg）。5年后评估每组心血管危险因素的患病率以及心血管发病率和死亡率。
两组运动前和运动峰值时的血压相似。然而，高血压反应组运动后的血压更高（收缩压分别为163±13 vs. 125±14 mmHg，p<0.01；舒张压分别为74±6 vs. 75±4 mmHg，p<0.01），运动后血压下降幅度更小（收缩压下降值分别为46.9±3.1 vs. 73.9±3.6 mmHg，p<0.01；舒张压下降值分别为12.4±1.5 vs. 26.5±2.2 mmHg，p<0.01），且运动后血压高于运动前血压（收缩压差值分别为24.5±3.5 vs. -6±4.1 mmHg，p<0.01；舒张压差值分别为19±2.1 vs. -13±2.3 mmHg，p<0.01）。5年后，高血压反应组血清胆固醇水平异常（p<0.01）、高血压（p<0.01）以及缺血性心脏病和脑血管病合并症的患病率更高（相对危险度1.32，95%可信区间=1.13 - 1.54，p<0.01）。
在运动应激试验评估期间，运动后5分钟评估血压很重要，因为在这个常规测量点血压下降幅度减小可识别出心血管风险较高的亚组。
