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Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Stanford Univ, CA 94305 USA; Stanford Univ, CA 94305 USA.
Stanford Univ, CA 94305 USA; Univ Leuven, Belgium.
Stanford Univ, CA 94305 USA.
Univ Leuven, Belgium.
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2019 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, article id UNSP 2047487319877268Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims The association between peak systolic blood pressure (SBP) during exercise testing and outcome remains controversial, possibly due to the confounding effect of external workload (metabolic equivalents of task (METs)) on peak SBP as well as on survival. Indexing the increase in SBP to the increase in workload (SBP/MET-slope) could provide a more clinically relevant measure of the SBP response to exercise. We aimed to characterize the SBP/MET-slope in a large cohort referred for clinical exercise testing and to determine its relation to all-cause mortality. Methods and results Survival status for male Veterans who underwent a maximal treadmill exercise test between the years 1987 and 2007 were retrieved in 2018. We defined a subgroup of non-smoking 10-year survivors with fewer risk factors as a lower-risk reference group. Survival analyses for all-cause mortality were performed using Kaplan-Meier curves and Cox proportional hazard ratios (HRs (95% confidence interval)) adjusted for baseline age, test year, cardiovascular risk factors, medications and comorbidities. A total of 7542 subjects were followed over 18.4 (interquartile range 16.3) years. In lower-risk subjects (n = 709), the median (95th percentile) of the SBP/MET-slope was 4.9 (10.0) mmHg/MET. Lower peak SBP (amp;lt;210 mmHg) and higher SBP/MET-slope (amp;gt;10 mmHg/MET) were both associated with 20% higher mortality (adjusted HRs 1.20 (1.08-1.32) and 1.20 (1.10-1.31), respectively). In subjects with high fitness, a SBP/MET-slope amp;gt; 6.2 mmHg/MET was associated with a 27% higher risk of mortality (adjusted HR 1.27 (1.12-1.45)). Conclusion In contrast to peak SBP, having a higher SBP/MET-slope was associated with increased risk of mortality. This simple, novel metric can be considered in clinical exercise testing reports.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2019. article id UNSP 2047487319877268
Keywords [en]
Mortality; clinical exercise testing; external workload; epidemiology
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-161627DOI: 10.1177/2047487319877268ISI: 000491527000001PubMedID: 31564136OAI: oai:DiVA.org:liu-161627DiVA, id: diva2:1367884
Note

Funding Agencies|Stanford Cardiovascular Institute; Swedish Fulbright Commission; Swedish Medical Society [SLS-682871]; Swedish Heart Foundation; County Council of Ostergotland,Sweden [LIO-804111]

Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05

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Hedman, Kristofer
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Clinical Physiology in Linköping
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