PS 05-32 BP & PR CHANGES DURING GXT PREDICT CV MORTALITY

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Abstract

Objective:

Some changes in blood pressure (BP) and pulse rate (PR) during and after a graded exercise tolerance test (GXT) are thought to predict coronary heart disease (CHD) or cardiovascular disease (CVD) mortality, but the few studies of the association in community-dwelling adults show conflicting results.

Design and Method:

We assessed the association of BP and PR change during GXT with CHD or CVD mortality in 939 older participants from the Rancho Bernardo Study without a history of CHD or CVD who were followed for up to 35 years. Main analyses divided participants into quartiles of change in systolic BP (SBP), diastolic BP (DBP), and PR.

Results:

During follow-up, there were 104 deaths from CHD and 100 deaths from other CVD. Participants in the lowest quartile of SBP change, with the smallest difference between maximal and baseline SBP, had a 3.19-fold increased CHD mortality risk. A maximal PR change in the lowest quartile was associated with a 3.69-fold increased CHD mortality risk. Less SBP change/PR change ratio was associated with a 3.52-fold increased CHD mortality risk, and exaggerated SBP change/PR change was associated with a 2.04-fold increased CHD mortality risk. Abnormal recovery of SBP or PR after exercise was also associated with an increased risk for CHD mortality.

Conclusions:

Inappropriate BP and PR responses during GXT, and delayed SBP and PR recovery after GXT are associated with long-term CHD mortality, as is an attenuated or exaggerated SBP change/PR change. These findings suggest that autonomic dysfunction during and after exercise may reflect very early preclinical stages of CVD.

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