de Liefde Inge I, Hoeks Sanne E, van Gestel Yvette R B M, Klein Jan, Verhagen Hence J M, van Domburg Ron T, Poldermans Don
Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands.
Coron Artery Dis. 2008 Dec;19(8):603-7. doi: 10.1097/MCA.0b013e328316e9ed.
A decline in systolic blood pressure during exercise is thought to be a sign of severe coronary artery disease. However, no studies have yet examined this effect in patients with known or suspected peripheral arterial disease. Therefore, we investigated the prognostic value of hypotensive blood pressure response after single-stage exercise test on long-term mortality, major adverse cerebrovascular and cardiac events (MACCE) and the effects of statin, beta-blocker and aspirin use in patients with known or suspected peripheral arterial disease.
A total of 2022 patients were enrolled in an observational study with a mean follow-up of 5 years. Hypotensive blood pressure response, 4.6% of the total population, was defined as a drop in exercise systolic blood pressure below resting systolic blood pressure.
Our study showed that hypotensive blood pressure response was associated with an increased risk of all-cause mortality [hazard ratio (HR): 1.74, 95% confidence interval (CI): 1.10-2.73] and MACCE (HR: 1.85, 95% CI: 1.14-3.00), independent of other clinical variables. Additionally, after adjustments for clinical risk factors and propensity score, baseline statin use was associated with a reduced risk of all-cause mortality (HR: 0.60, 95% CI: 0.44-0.80). Besides, statin and aspirin use were both also associated with a reduced risk of MACCE (HR: 0.65, 95% CI: 0.47-0.89 and HR: 0.69, 95% CI: 0.53-0.88, respectively).
Hypotensive blood pressure response after single-stage treadmill exercise tests in patients with known or suspected peripheral arterial disease was associated with a higher risk for all-cause long-term mortality and MACCE, which might be reduced by statin and aspirin use.
运动期间收缩压下降被认为是严重冠状动脉疾病的一个迹象。然而，尚无研究在已知或疑似外周动脉疾病的患者中考察这种效应。因此，我们调查了单阶段运动试验后血压降低反应对长期死亡率、主要不良脑血管和心脏事件（MACCE）的预后价值，以及他汀类药物、β受体阻滞剂和阿司匹林的使用在已知或疑似外周动脉疾病患者中的作用。
共有2022例患者纳入一项观察性研究，平均随访5年。血压降低反应在总人群中占4.6%，定义为运动收缩压降至静息收缩压以下。
我们的研究表明，血压降低反应与全因死亡率增加相关[风险比（HR）：1.74，95%置信区间（CI）：1.10 - 2.73]以及MACCE（HR：1.85，95%CI：1.14 - 3.00），独立于其他临床变量。此外，在调整临床风险因素和倾向得分后，基线使用他汀类药物与全因死亡率风险降低相关（HR：0.60，95%CI：0.44 - 0.80）。此外，使用他汀类药物和阿司匹林也均与MACCE风险降低相关（HR分别为：0.65，95%CI：0.47 - 0.89；HR：0.69，95%CI：0.53 - 0.88）。
在已知或疑似外周动脉疾病的患者中，单阶段平板运动试验后血压降低反应与全因长期死亡率和MACCE的较高风险相关，而他汀类药物和阿司匹林的使用可能会降低这种风险。
