Systolic Blood Pressure Response During Exercise Stress Testing: the Henry Ford ExercIse Testing (FIT) Project

Background: the prognostic significance of modest elevations in exercise systolic blood pressure response has not been extensively examined.methods and results: we examined the association between systolic blood pressure response and all-cause death and incident myocardial infarction (mi) in 44 089 (mean age 53±13 years,45% female,26% black) patients who underwent exercise treadmill stress testing from the henry ford exercise testing (fit) project (1991-2010). exercise systolic blood pressure response was examined as a categorical variable (>20 mm hg: referent; 1 to 20 mm hg,and ≤0 mm hg) and per 1 sd decrease. cox regression was used to compute hazard ratios (hr) and 95% ci for the association between systolic blood pressure response and all-cause death and incident mi. over a median follow-up of 10 years,a total of 4782 (11%) deaths occurred and over 5.2 years,a total of 1188 (2.7%) mis occurred. in a cox regression analysis adjusted for demographics,physical fitness,and cardiovascular risk factors,an increased risk of death was observed with decreasing systolic blood pressure response (>20 mm hg: hr=1.0,referent; 1 to 20 mm hg: hr=1.13,95% ci=1.05,1.22; ≤0 mm hg: hr=1.21,95% ci=1.09,1.34). a trend for increased mi risk was observed (>20 mm hg: hr=1.0,referent; 1 to 20 mm hg: hr=1.09,95% ci=0.93,1.27; ≤0 mm hg: hr=1.19,95% ci=0.95,1.50). decreases in systolic blood pressure response per 1 sd were associated with an increased risk for all-cause death (hr=1.08,95% ci=1.05,1.11) and incident mi (hr=1.09,95% ci=1.03,1.16).conclusions: our results suggest that modest increases in exercise systolic blood pressure response are associated with adverse outcomes. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.