Exercise blood pressure predicts cardiovascular death and myocardial infarction

OBJECTIVE: To investigate whether the exercise systolic blood pressure predicts cardiovascular morbidity and mortality and in particular myocardial infarction beyond that prediction provided by the casual blood pressure at rest and independently of other cardiovascular risk factors. METHODS: We performed an average 16-year follow-up of 1999 middle-aged healthy men. RESULTS: We found that the systolic blood pressure during 6 min on a moderate load during a bicycle ergometer exercise test was a stronger predictor of total cardiovascular mortality and of morbidity and mortality from myocardial infarction than was the blood pressure of the subjects at rest. Furthermore, an early rise in systolic blood pressure during exercise seems to add prognostic information only when the systolic blood pressure of the subject at rest is elevated mildly (>/= 140 mmHg). Subjects whose systolic blood pressure increased to >/= 200 mmHg had a more than twofold greater risk of dying from cardiovascular causes and from myocardial infarction in particular within 16 years than did normotensives and men whose systolic blood pressure was >/= 140 mmHg when they were at rest whose systolic blood pressure did not increase to a similar extent, after we had adjusted for differences in age and a rather large number of traditional risk factors for cardiovascular disease. CONCLUSION: We suggest that systolic blood pressures recorded during standardized ergometer exercise testing may help one to distinguish between severe and less severe cases of hypertension among middle-aged men.