Diagnostic Value of Exercise Stress Testing Combined With Beta-Blocker Therapy (Metoprolol) in Hypertensive Patients
Humayun Nasir1, Awais Ahmad Nizami2, Mamoon Qadir3,4
1General Medicine, George Eliot Hospital, Warwickshire, GBR.
Insights
Combining exercise stress testing (EST) with metoprolol in hypertensive patients with suspected coronary artery disease (CAD) offers a valuable non-invasive diagnostic approach. This strategy demonstrates high specificity and positive predictive value for diagnosing CAD.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Pharmacology
Background:
- Hypertension is a significant risk factor for coronary artery disease (CAD).
- Early diagnosis of CAD in hypertensive patients is crucial for preventing adverse cardiovascular events.
- The diagnostic performance of exercise stress testing (EST) in hypertensive patients, particularly those on beta-blockers, requires further evaluation.
Purpose of the Study:
- To assess the diagnostic utility of EST combined with metoprolol therapy in hypertensive individuals with suspected CAD.
- To determine the sensitivity, specificity, and predictive values of this combined diagnostic approach.
Main Methods:
- A prospective, hospital-based diagnostic study involving 224 hypertensive patients (30-70 years) with suspected CAD.
- Participants received oral metoprolol 50 mg one hour before EST using the Bruce protocol.
- Coronary angiography or myocardial perfusion imaging (MPI) served as the gold standard for CAD confirmation.
Main Results:
- Of 224 patients, 94 (41.96%) had confirmed CAD.
- The combination of EST and metoprolol achieved a sensitivity of 72.34%, specificity of 86.15%, PPV of 79.07%, and NPV of 81.16%.
- Overall diagnostic accuracy for CAD was 80.36%.
Conclusions:
- Combining EST with metoprolol is a viable non-invasive strategy for diagnosing CAD in hypertensive patients.
- This approach offers high specificity and positive predictive value, aiding in the accurate identification of CAD in this population.
Background:
Hypertension is a prevalent risk factor for coronary artery disease (CAD), and early diagnosis is critical for preventing adverse cardiovascular events. While exercise stress testing (EST) is a common non-invasive tool, its diagnostic performance in hypertensive individuals, especially when combined with beta-blocker therapy, remains under-evaluated. The beta-blocker metoprolol may enhance diagnostic accuracy in this population.
Objective:
This study aimed to evaluate the diagnostic value of EST combined with metoprolol therapy in hypertensive patients with suspected CAD.
Methodology:
This prospective, hospital-based controlled diagnostic study was conducted at the Department of Cardiology, Abbas Institute of Medical Science (AIMS), Muzaffarabad, Azad Jammu and Kashmir (AJK), from January 2023 to December 2024. A total of 224 hypertensive patients aged between 30 and 70 years with clinical suspicion of CAD (based on anginal symptoms, ECG changes, or physician judgment) were enrolled. Patients with a known history of CAD, contraindications to exercise or beta-blockers, or current beta-blocker use were excluded. All participants received a single oral dose of 50 mg metoprolol tartrate one hour prior to EST, performed using the Bruce protocol. Adverse effects and hemodynamic responses were monitored. A positive EST was defined by ischemic ECG changes, anginal symptoms, or abnormal blood pressure response. All patients underwent confirmatory testing with either coronary angiography or myocardial perfusion imaging (MPI), depending on clinical indication. Diagnostic metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated using confirmed CAD status as the gold standard. Confidence intervals were calculated to assess the precision of diagnostic estimates. Data were analyzed using IBM SPSS Statistics software, version 25.0 (IBM Corp., Armonk, NY), with categorical variables reported as frequencies and percentages, continuous variables as mean ± SD, and diagnostic accuracy of EST with metoprolol evaluated against confirmed CAD using sensitivity, specificity, PPV, NPV, and chi-square test (p < 0.05).
Results:
Out of 224 patients, 138 (61.61%) had a negative EST and 86 (38.39%) had a positive result. CAD was confirmed in 94 patients (41.96%). Of the 86 patients with a positive EST, 68 (79.07%) had confirmed CAD. Among the 138 patients with a negative EST, 26 (18.84%) were found to have CAD. The combination of EST and metoprolol demonstrated a diagnostic sensitivity of 72.34%, specificity of 86.15%, PPV of 79.07%, NPV of 81.16%, and an overall diagnostic accuracy of 80.36%.
Conclusion:
In hypertensive patients with suspected CAD, combining EST with metoprolol provides a viable and non-invasive diagnostic strategy, offering high specificity and PPV despite moderate sensitivity.
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