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(Hypertension. 1996;27:324-329.)
© 1996 American Heart Association, Inc.
Articles |
Exercise Blood Pressure Predicts Mortality From Myocardial Infarction
From the Department of Internal Medicine, Central Hospital of Akershus, Nordbyhagen, and the Division of Cardiology, Department of Internal Medicine, Ullevaal University Hospital (S.E.K.), Oslo, Norway.
Abstract Apparently healthy men (n=1999, 40 to 59 years
old)
were investigated from 1972 through 1975 to determine whether
systolic blood pressure during bicycle ergometer exercise
predicts morbidity and mortality from myocardial infarction beyond that
of casual blood pressure taken after 5 minutes of supine rest. During a
follow-up of 31 984 patient-years (average, 16 years), 235
subjects had myocardial infarctions, of which 143 were nonfatal and 92
were fatal. Exercise blood pressure was more strongly related than
casual blood pressure to both morbidity and mortality from myocardial
infarction. Among 520 men with casual systolic blood pressure
140 mm Hg, 304 increased their systolic blood pressure to
200 mm Hg during 6 minutes of exercise at an initial workload of 600
kpm/min. These 304 men had an excessive risk of myocardial infarction
(18.8% versus 9.5% among the 1294 men with casual blood pressure
<140 mm Hg and exercise blood pressure <200 mm Hg;
P<.001). As many as 58% of those with myocardial
infarction in this group died, compared with 33% (range, 26% to 35%)
for all other groups (P=.0011), including those with casual
blood pressure 140 mm Hg and exercise blood pressure <200 mm Hg.
Thus, exercise blood pressure is a stronger predictor than casual blood
pressure of morbidity and mortality from myocardial infarction, and an
early rise in systolic blood pressure during exercise adds
prognostic information about mortality from myocardial infarction among
otherwise healthy middle-aged men with mildly elevated casual blood
pressure. We suggest that blood pressure taken during standardized
exercise testing may distinguish between severe and less severe
hypertension.
Key Words: blood pressure • morbidity • mortality • exercise test • myocardial infarction
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