BP response during treadmill test predicts risk of cardiovascular events, hypertension

Measuring blood pressure (BP) during rest, exercise, and recovery phases of exercise stress training (EST) can offer incremental prognostic information on the long-term risk for cardiovascular events and the probability for developing hypertension, suggests a recent study.

A team of investigators conducted a retrospective analysis of treadmill ESTs (2005–2019) using the Bruce protocol in patients aged 35–75 years with no history of cardiovascular disease (n=14,792; 48 percent women). They recorded BP at rest, submaximal exercise (Bruce stage 2), peak exercise, and recovery (2 min). The association between systolic BP measures and study outcomes during a median follow-up of 6.5 years was also assessed.

The highest vs lowest systolic BP quartile at rest (≥140 vs <120 mm Hg), submaximal exercise (≥170 vs <130 mm Hg), peak exercise (≥180 vs ≤145 mm Hg), and recovery (≥160 vs <130 mm Hg) correlated with an increased risk for major adverse cardiovascular event (MACE; at rest: adjusted hazard ratio [aHR], 1.53, 95 percent confidence interval [CI], 1.23–1.88; at submaximal exercise: aHR, 1.33, 95 percent CI, 1.01–1.76; at peak exercise: aHR, 1.30, 95 percent CI, 1.05–1.61; at recovery: aHR, 1.35, 95 percent CI, 1.09–1.68, respectively).

A J-shaped association was observed between systolic BP at submaximal exercise and recovery and MACE. Moreover, excessive systolic BP response to peak exercise (≥190 mm Hg in women and ≥210 mm Hg in men) independently predicted hypertension (HR, 1.87, 95 percent CI, 1.41–2.48), as were systolic BPs during submaximal exercise (>160 vs ≤130 mm Hg; HR, 2.44, 95 percent CI, 1.97–3.03) and recovery (≥140 vs ≤120 mm Hg; HR, 1.65, 95 percent CI, 1.37–1.98).

“The physiologic response to exercise may provide valuable prognostic information,” the investigators said.