Weiner D A, McCabe C H, Cutler S S, Ryan T J
Am J Cardiol. 1982 May;49(7):1627-31. doi: 10.1016/0002-9149(82)90238-7.
To investigate the reproducibility and prognostic significance of an exercise-induced decrease in systolic blood pressure, 47 patients were identified who manifested such a reduction below the pre-exercise standing level in a consecutive series of 436 patients who underwent treadmill exercise testing and cardiac catheterization during a 3 year period. The prevalence of this abnormal finding was 11 percent in the total group but 21 percent in the 124 patients with three vessel or left main coronary artery disease. Patients with an exercise-induced reduction in systolic blood pressure were more likely to be male, have typical angina pectoris with class III or IV functional limitation and to have had a prior myocardial infarction than were patients without this finding (p less than 0.05). Although no complications occurred during the exercise test of these 47 patients, the majority had severe ischemic responses and 14 (30 percent) showed complex repetitive ventricular arrhythmias. Of the 47 patients, 24 (group 1a) received medical treatment and 23 (group 1b) underwent coronary bypass surgery. On repeat exercise testing in 42 patients, a decrease in systolic blood pressure during exercise was consistently present in group 1a (17 of 20) but entirely absent (0 of 22) in group 1b (p less than 0.001). The mean treadmill time, peak heart rate and systolic blood pressure were not significantly different in the initial and on repeat exercise tests in patients in group 1a; however, in patients in group 1b, all of these variables were significantly higher in the repeat test (p less than 0.001). At a mean follow-up time of 37 months, the total cardiac mortality rate was 8 percent (2 of 24) in group 1a and 4 percent (1 of 23) in group 1b. It is concluded that a decrease in systolic blood pressure during exercise testing is highly reproducible and appears to be reversed by coronary bypass surgery.
为研究运动诱发的收缩压降低的可重复性及预后意义，在连续436例于3年期间接受平板运动试验和心导管检查的患者中，识别出47例运动后收缩压降至运动前站立水平以下的患者。这一异常发现的发生率在总体组中为11%，但在124例三支血管病变或左主干冠状动脉疾病患者中为21%。与无此发现的患者相比，运动诱发收缩压降低的患者更可能为男性，有Ⅲ或Ⅳ级功能受限的典型心绞痛，且曾有心肌梗死病史（p<0.05）。尽管这47例患者在运动试验期间未发生并发症，但大多数有严重缺血反应，14例（30%）出现复杂的反复室性心律失常。47例患者中，24例（1a组）接受药物治疗，23例（1b组）接受冠状动脉搭桥手术。在42例患者的重复运动试验中，1a组（20例中的17例）运动期间收缩压持续降低，而1b组（22例中的0例）完全未出现降低（p<0.001）。1a组患者初始运动试验和重复运动试验的平均平板运动时间、峰值心率和收缩压无显著差异；然而，1b组患者重复试验中所有这些变量均显著更高（p<0.001）。平均随访37个月时，1a组的总心脏死亡率为8%（24例中的2例），1b组为4%（23例中的1例）。结论是运动试验期间收缩压降低具有高度可重复性，且冠状动脉搭桥手术似乎可使其逆转。
