Department of Cardiology, Lady Davis Carmel Medical Center.
Faculty of Medicine, Technion, Israel Institute of Technology.
J Hypertens. 2022 Jan 1;40(1):143-152. doi: 10.1097/HJH.0000000000002991.
The physiologic response to exercise may provide valuable prognostic information. We investigated the association of blood pressure (BP) measurements during exercise stress testing (EST) with long-term risk of myocardial infarction, stroke or death (major adverse cardiovascular event, MACE), as well as the development of new-onset hypertension.
A retrospective analysis of treadmill ESTs (years 2005-2019) performed by the Bruce protocol in patients aged 35-75 years without a history of cardiovascular disease (n = 14 792; 48% women). BP was documented at rest, submaximal exercise (Bruce stage-2), peak exercise and recovery (2 min). Association of SBP measures with study outcomes during median follow-up of 6.5 years was investigated.
Highest vs. lowest SBP quartile at rest (≥140 vs. <120 mmHg), submaximal-exercise (≥170 vs. <130 mmHg), peak-exercise (≥180 vs. ≤145 mmHg) and recovery (≥160 vs. <130 mmHg) was associated with an increase in the adjusted hazard ratio and 95% confidence interval (CI) for MACE: 1.53 (1.23-1.88), 1.33 (1.01-1.76), 1.30 (1.05-1.61), 1.35 (1.09-1.68), respectively. The association between SBP at submaximal exercise and recovery with MACE displayed a J-shaped pattern. Among nonhypertensive patients (n = 8529), excessive SBP response to peak exercise (≥190 mmHg in women and ≥210 mmHg in men) was an independent predictor of hypertension [hazard ratio (95% CI)]: 1.87 (1.41-2.48), as were SBPs during submaximal exercise [>160 vs. ≤130 mmHg: 2.44 (1.97-3.03)] and recovery [≥140 vs. ≤120 mmHg: 1.65 (1.37-1.98)].
BP measurement during rest, exercise and recovery phases of EST provides incremental prognostic information regarding long-term risk for cardiovascular events and the probability for developing hypertension.
运动时的生理反应可能提供有价值的预后信息。我们研究了运动应激试验（EST）期间的血压（BP）测量值与心肌梗死、中风或死亡（主要不良心血管事件，MACE）的长期风险之间的关系，以及新发高血压的发展。
对 2005 年至 2019 年间按布鲁斯方案进行的 14792 例年龄 35-75 岁、无心血管疾病史的患者（48%为女性）的跑步机 EST 进行回顾性分析。在休息时、亚最大运动（布鲁斯 2 级）、最大运动和恢复期（2 分钟）记录 BP。在中位随访 6.5 年期间，研究了 SBP 测量值与研究结果之间的关系。
与休息时（≥140 vs. <120mmHg）、亚最大运动时（≥170 vs. <130mmHg）、最大运动时（≥180 vs. ≤145mmHg）和恢复期（≥160 vs. <130mmHg）时最高 SBP 四分位与调整后的危险比和 95%置信区间（CI）的 MACE 增加相关：1.53（1.23-1.88）、1.33（1.01-1.76）、1.30（1.05-1.61）、1.35（1.09-1.68），分别。亚最大运动和恢复期 SBP 与 MACE 之间的关联呈 J 形模式。在非高血压患者（n=8529）中，最大运动时的 SBP 反应过度（女性≥190mmHg，男性≥210mmHg）是高血压的独立预测因子[危险比（95%CI）]：1.87（1.41-2.48），亚最大运动时的 SBP 也如此[>160 vs. ≤130mmHg：2.44（1.97-3.03）]和恢复期[≥140 vs. ≤120mmHg：1.65（1.37-1.98）]。
EST 休息、运动和恢复期的 BP 测量提供了关于心血管事件长期风险和发生高血压概率的增量预后信息。
