Key result
Elevated exercise SBP/MET peak is linked to ~2% higher MACE risk per 1-unit increase.
Why the study?
Exercise systolic blood pressure indexed to fitness (SBP/MET peak) is associated with cardiovascular events, but the specific cardiac phenotype and long-term outcomes of patients with elevated exercise SBP indexed to fitness needed to be characterised.
Does elevated exercise systolic blood pressure indexed to fitness (SBP/MET peak ≥18 mm Hg/METs) predict major adverse cardiovascular events and coronary artery disease in patients with suspected angina?
Cohort (n=530)
Does elevated exercise systolic blood pressure indexed to fitness (SBP/MET peak ≥18 mm Hg/METs) predict major adverse cardiovascular events and coronary artery disease in patients with suspected angina?
Hazard Ratio: 1.02 (95% CI 1–1.03)
p-value: p=0.012
In patients with suspected angina, an elevated exercise systolic blood pressure to fitness ratio (SBP/MET peak) is associated with greater coronary disease burden, myocardial ischemia/scar, and worse long-term cardiovascular outcomes over 15.9 years, though driven primarily by reduced exercise capacity.
Background Exercise systolic blood pressure (SBP) indexed to fitness, expressed as SBP divided by peak metabolic equivalents (SBP/MET peak), is associated with cardiovascular events in patients undergoing exercise testing. We aimed to characterise the cardiac phenotype and outcomes of patients with elevated exercise SBP indexed to fitness.Methods We analysed 530 participants with suspected angina from the CE-MARC trial who had complete exercise treadmill testing, invasive coronary angiography (ICA) and cardiovascular magnetic resonance (CMR) imaging. High SBP/MET peak was defined as ≥18 mm Hg/METs. Obstructive coronary artery disease (CAD) was defined by quantitative ICA as ≥70% stenosis in a major epicardial artery. Inducible ischaemia and myocardial scar were assessed by stress perfusion and late gadolinium enhancement CMR, respectively. Major adverse cardiovascular events (MACE) were defined as all-cause death and acute coronary syndrome.Results High SBP/MET peak was present in 310 participants (58.5%) and prevalence increased progressively with the number of diseased vessels, presence of ischaemia and myocardial scar (p<0.01 for all). During a median follow-up of 15.9 years, high SBP/METpeak was associated with MACE after adjustment for age, sex, obstructive CAD, ischaemia and myocardial scar (adjusted HR per 1-unit increase, 1.02 (95% CI 1.00 to 1.03), p=0.012). Higher SBP/METpeak identified a worse prognosis in subgroups with and without obstructive CAD and in those with and without ischaemia or infarction (log-rank, p<0.005 for all).Conclusions Among patients with suspected angina, high SBP/MET peak was associated with myocardial ischaemia and scar and adverse long-term outcomes. However, this association appeared to be driven predominantly by lower exercise capacity rather than peak SBP. SBP/METpeak may therefore represent an exploratory integrated exercise marker requiring external validation.
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Takafuji et al. (2026) conducted a cohort in Suspected angina / coronary artery disease (n=530). High exercise systolic blood pressure indexed to fitness (SBP/MET peak ≥18 mm Hg/METs) vs. Lower SBP/MET peak (<18 mm Hg/METs) was evaluated on Major adverse cardiovascular events (MACE), defined as all-cause death and acute coronary syndrome (adjusted HR 1.02 per 1-unit increase, 95% CI 1.00-1.03, p=0.012). Elevated exercise SBP/MET peak was associated with long-term MACE in patients with suspected angina (adjusted HR 1.02 per 1-unit increase; 95% CI 1.00-1.03; p=0.012).
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