Evaluation of hypertensive males for primary coronary heart disease events using conventional risk factors and maximal exercise testing

Whereas hypertension is a risk factor for primary coronary heart disease events, the relative contributions of other risk factors and abnormal responses to symptom-limited maximal exercise are not well-established. After 5.2 +/- 1.5 years of follow-up of 633 men with clinically-diagnosed hypertension based upon criteria of examining physicians (whether or not the men were currently treated for hypertension), 54 primary events were revealed. The annual coronary heart disease (CHD) event rate of 16.9/1000 men at risk was significantly higher than the annual rate of 3.6/1000 found for healthy men (p < 0.0001). Variables associated with increased risk were smoking cigarettes, risk factor count or tally, chest pain during exercise, percentage of functional aerobic impairment, and percentage heart rate impairment, the latter two variables suggesting early evidence of left ventricular dysfunction on strenuous exertion. Ischemic ST depression was not an important predictor. The three exercise variables were included in an exercise predictor count, and multivariate analysis revealed that this count and the risk factor count were the most important predictors of primary CHD events. Combining the risk factor count and the exercise predictor count, three groups with increasing risk of primary CHD events were identified. In those persons with both a risk factor count and exercise predictor count of zero, the annual rate was 7.3 events/1000 man-years; when either count was one or more, the rate was 15.5 events/1000 man-years; when both counts were one or more, the rate was 49.5 events/1000 man-years.