Usefulness of Hypertensive Blood Pressure Response During a Single-Stage Exercise Test to Predict Long-Term Outcome in Patients With Peripheral Arterial Disease

• Published in: The American journal of cardiology Vol. 102; no. 7; pp. 921 - 926
• Main Authors: de Liefde, Inge I., MD, Hoeks, Sanne E., MD, van Gestel, Yvette R.B.M., MD, Bax, Jeroen J., MD, PhD, Klein, Jan, MD, PhD, van Domburg, Ron T., MD, PhD, Poldermans, Don, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2008; Elsevier; Elsevier Limited
• Subjects: Adrenergic beta-Antagonists - administration & dosage; Aged; Arterial hypertension. Arterial hypotension; Aspirin - administration & dosage; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Blood Pressure - drug effects; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cause of Death; Clinical outcomes; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Exercise; Exercise Test; Female; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hypertension; Hypertension - physiopathology; Male; Medical sciences; Middle Aged; Peripheral Vascular Diseases - physiopathology; Predictive Value of Tests; Prognosis; Prospective Studies; Registries; Risk Factors; Surveys and Questionnaires; Survival Analysis; Physical exercise; Human; Hypertension; Prognosis; Prediction; Cardiovascular disease; Long term; Arterial disease; Vascular disease; Response; Occlusive arterial disease; Exercise tolerance test; Evolution; Arterial pressure; Blood pressure; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.05.032

The prognostic value of a hypertensive blood pressure (BP) response is still unclear. Therefore, the prognostic value of a hypertensive BP response in patients during single-stage exercise testing for peripheral arterial disease (PAD) on long-term mortality and major adverse cerebrovascular and cardiac events (MACCEs) was investigated. In addition, effects of statin, β-blocker, and aspirin use in patients with known or suspected PAD were studied. A total of 2,109 patients were enrolled in an observational prospective study from 1993 to 2005. Hypertensive BP response was defined as an increase in systolic BP ≥55 mm Hg (95th percentile within our population) after a single-stage treadmill exercise test. The outcome was obtained by using the civil registries, and a questionnaire about cardiac events was sent to all survivals. Hypertensive BP response was associated with increased risk of long-term mortality (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12 to 1.80) and MACCEs (HR 1.47, 95% CI 1.09 to 1.97). After adjustments for clinical risk factors and propensity score, baseline statin use was associated with reduced risk of long-term mortality (HR 0.59, 95% CI 0.44 to 0.79), and statin, β-blocker, and aspirin use were associated with reduced risk of MACCEs (HR 0.59, 95% CI 0.43 to 0.81; HR 0.75, 95% CI 0.60 to 0.95; HR 0.73, 95% CI, 0.57 to 0.92, respectively). In conclusion, hypertensive BP response at exercise in patients with known or suspected PAD is an important independent risk factor for all-cause long-term mortality and MACCEs, whereas statin, β-blocker, and aspirin use were associated with an improved outcome.