Mundal R, Kjeldsen S E, Sandvik L, Erikssen G, Thaulow E, Erikssen J
Department of Internal Medicine, Central Hospital of Akershus, Norbyhagen, Norway.
Hypertension. 1996 Mar;27(3 Pt 1):324-9. doi: 10.1161/01.hyp.27.3.324.
Apparently healthy men (n=1999, 40 to 59 years old) were investigated from 1972 through 1975 to determine whether systolic blood pressure during bicycle ergometer exercise predicts morbidity and mortality from myocardial infarction beyond that of casual blood pressure taken after 5 minutes of supine rest. During a follow-up of 31 984 patient-years (average, 16 years), 235 subjects had myocardial infarctions, of which 143 were nonfatal and 92 were fatal. Exercise blood pressure was more strongly related than casual blood pressure to both morbidity and mortality from myocardial infarction. Among 520 men with casual systolic blood pressure = 140 mm Hg, 304 increased their systolic blood pressure to > or = 200 mm Hg during 6 minutes of exercise at an initial workload of 600 kpm/min. These 304 men had an excessive risk of myocardial infarction (18.8% versus 9.5% among the 1294 men with casual blood pressure < 140 mm Hg and exercise blood pressure < 200 mm Hg; P < .001). As many as 58% of those with myocardial infarction in this group died, compared with 33% (range, 26% to 35%) for all other groups (P=.0011), including those with casual blood pressure > or = 140 mm Hg and exercise blood pressure < 200 mm Hg. Thus, exercise blood pressure is a stronger predictor than casual blood pressure of morbidity and mortality from myocardial infarction, and an early rise in systolic blood pressure during exercise adds prognostic information about mortality from myocardial infarction among otherwise healthy middle-aged men with mildly elevated casual blood pressure. We suggest that blood pressure taken during standardized exercise testing may distinguish between severe and less severe hypertension.
1972年至1975年期间，对表面健康的男性（n = 1999，年龄在40至59岁之间）进行了调查，以确定自行车测力计运动期间的收缩压是否比仰卧休息5分钟后测得的偶测血压更能预测心肌梗死的发病率和死亡率。在31984患者年（平均16年）的随访期间，235名受试者发生了心肌梗死，其中143例为非致命性，92例为致命性。运动血压比偶测血压与心肌梗死的发病率和死亡率的相关性更强。在520名偶测收缩压 = 140 mmHg的男性中，304人在初始工作量为600 kpm/min的6分钟运动期间，收缩压升高至≥200 mmHg。这304名男性发生心肌梗死的风险过高（偶测血压<140 mmHg且运动血压<200 mmHg的1294名男性中为9.5%，而这组中为18.8%；P < .001）。该组中心肌梗死患者的死亡率高达58%，而所有其他组（包括偶测血压≥140 mmHg且运动血压<200 mmHg的组）为33%（范围为26%至35%）（P = .0011）。因此，运动血压比偶测血压更能预测心肌梗死患者的发病率和死亡率，并且在运动期间收缩压的早期升高为表面健康、偶测血压轻度升高的中年男性心肌梗死死亡率提供了预后信息。我们建议在标准化运动试验期间测量的血压可区分重度和轻度高血压。
