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(Hypertension. 2004;44:807.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Blunted Decline in Systolic Blood Pressure After Exercise Predicts Future Acute Myocardial Infarction

From the Mount Sinai School of Medicine of the New York University, New York City; and the Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY.

Correspondence to John E. Madias, MD, Professor of Medicine (Cardiology), Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373. E-mail madiasj@nychhc.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Predicting an acute myocardial infarction (AMI), within the context of physicians’ or epidemiologists’ realms, is an important task. Accordingly, the recovery period after an exercise stress test has been subjected recently to scrutiny, with very fruitful results. Traditionally, the time after completion of an exercise stress test has been merely devoted to observing the patients for clinical symptoms, without much thought given to a possible diagnostic utility of information generated during the recovery period. However, in the past few years, diagnostically important data from the recovery period have been forthcoming. An early example was the observation that in >15% of patients subjected to exercise testing, electrocardiographic (ECG) ST-segment depression occurred only during recovery,¹ a finding with a predictive value of significant coronary artery disease not different from that associated with ECG changes occurring during exercise. Also, recent work has documented a relationship between postexercise blunted drop of heart rate and subsequent morbidity and mortality.^2–4

In the same context, delayed decrease of the systolic blood pressure (SBP) during the recovery period after exercise has been linked recently to an increased risk of coronary heart disease, stroke, and emergence of hypertension.^5–8 According to these new ideas, SBP and heart rate, at various designated time points during recovery,^4–8 become new "risk factors," and it is the task of researchers and users to validate their incremental value above the "established" indices of risk.

In this issue of Hypertension, Laukannen et al report on an important role of SBP at 2' of recovery for . . . [Full Text of this Article]