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Differential Impacts of Resting and Exercise-related Blood Pressure Changes on Cardiovascular and All-cause
Dan-Ying Lee1,2,3, Chi-Jung Huang4,5, Chen-Huan Chen1,3,5,6
1Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Background:
The prognostic significance of BP changes during exercise remains unclear. This study investigated the association between exercise-related BP and long-term mortality.
Methods:
We analyzed 19,110 individuals (mean age 57.9 years, 61.9% men) who underwent clinically indicated treadmill exercise testing. The recordings of BP throughout the test were obtained, and maximal and recovery changes in SBP (ΔSBPmax and ΔSBPrec) were calculated. Mortality and cardiovascular (CV) death were obtained via linkage to the National Death Registry.
Results:
During a mean follow-up of 4.4 ± 2.6 years, there were 649 deaths and 134 CV deaths. Higher resting SBP, recovery SBP, maximal exercise SBP, peak heart rate, ΔSBPmax, and ΔSBPrec were inversely associated with CV and all-cause mortality. In contrast, a drop in recovery SBP below resting levels was associated with higher mortality. After multivariable adjustment for age, sex, lipid profiles, diabetes, use of antihypertensive agents, resting SBP, and metabolic equivalents, both ΔSBPmax and ΔSBPrec remained independently predictive. Specifically, for per 1-SD increase, ΔSBPmax was associated with a hazard ratio (HR) of 0.80 (95% CI, 0.67-0.97) for CV death and 0.88 (95% CI, 0.80-0.96) for all-cause death. Similarly, ΔSBPrec was associated with an HR of 0.75 (95% CI, 0.62-0.90) for CV death and 0.85 (95% CI, 0.77-0.93) for all-cause death.
Conclusions:
Greater SBP increases during exercise and recovery were associated with lower CV and all-cause mortality, while a drop in recovery SBP identified elevated risk. Exercise BP responses may serve as simple, clinically relevant prognostic markers.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.