Key result
Resting blood pressure >130/80 mmHg, middle age, known hypertension, smoking, and family history of premature CAD were independent risk factors for exaggerated blood pressure response (all P<0.001).
Why the study?
Exaggerated blood pressure response to exercise stress testing may mark future hypertension and predict cardiovascular events, but clinical and resting parameters associated with it needed evaluation.
What are the clinical and resting parameters associated with an exaggerated blood pressure response during exercise stress testing in patients without known cardiovascular disease?
Observational (n=14,073)
What are the clinical and resting parameters associated with an exaggerated blood pressure response during exercise stress testing in patients without known cardiovascular disease?
p-value: p=<0.001
Resting blood pressure >130/80 mmHg and other clinical factors independently predict an exaggerated blood pressure response during exercise stress testing, highlighting targets for early preventive interventions.
May refine risk stratification for exaggerated BP response; leaves open need for prospective validation before practice change.
BACKGROUND: Exaggerated blood pressure response (EBPR) to exercise stress testing (EST) may be a marker of future hypertension and carry valuable information for the prediction of cardiovascular events. We sought to evaluate the clinical and resting EST parameters associated with an increased likelihood of EBPR. METHODS: The records of 14,073 patients (mean age: 55 ± 11 years) without known cardiovascular disease who underwent a treadmill EST were analyzed. RESULTS: The overall prevalence of arterial hypertension was 44%. A considerable proportion (24%) of patients exhibited EBPR. Multivariate analysis of the entire study population showed that middle-aged individuals (40-60 years old), resting systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg, known arterial hypertension, current cigarette smoking, and family history of premature coronary artery disease are all independent risk factors for EBPR (all P < 0.001). Although the presence of arterial hypertension increased the likelihood of EBPR in the analysis of the entire population, the relevant association in subjects above 60 years old is statistically nonsignificant (P = 0.120). Notably, the pre-test systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg level increased significantly the likelihood of manifesting EBPR in all age categories (<40, 40-60, and >60 years old) independent of hypertension presence and in all hypertensive patients independently of antihypertensive treatment intake (all P < 0.001). CONCLUSIONS: Considering the diagnostic and prognostic utility of EBPR during treadmill EST the clinical and resting hemodynamic parameters that increase the likelihood of EBPR are targets for interventions and preventive measures to modify lifestyle risk behaviors and reduce hypertension and cardiovascular risk factors in the early stages.
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Katsi et al. (2024) conducted an observational in Without known cardiovascular disease undergoing treadmill exercise stress testing (n=14,073). Clinical and resting hemodynamic risk factors (e.g., resting BP >130/80 mmHg, smoking) vs. Absence of these risk factors was evaluated on Exaggerated blood pressure response (EBPR) (p=<0.001). Resting blood pressure >130/80 mmHg, middle age, known hypertension, smoking, and family history of premature CAD were independent risk factors for exaggerated blood pressure response (all P<0.001).
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