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.