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Evaluation of hypertensive males for primary coronary heart disease events using conventional risk factors and
Insights
Hypertension increases coronary heart disease (CHD) risk. Exercise impairment and risk factor count are key predictors of CHD events in hypertensive men, highlighting the importance of assessing both factors.
Area of Science:
- Cardiology
- Preventive Medicine
- Exercise Physiology
Background:
- Hypertension is a known risk factor for coronary heart disease (CHD).
- The combined impact of other risk factors and exercise response on CHD events in hypertensive individuals requires further investigation.
- Understanding these factors is crucial for refining risk stratification and preventive strategies.
Purpose of the Study:
- To evaluate the predictive value of various risk factors and abnormal exercise responses for primary coronary heart disease (CHD) events in men with hypertension.
- To determine the relative importance of traditional risk factors versus exercise-related variables in predicting CHD events.
- To develop a combined risk score integrating traditional risk factors and exercise parameters.
Main Methods:
- Follow-up study of 633 men with clinically diagnosed hypertension over 5.2 years.
- Assessment of traditional risk factors (e.g., smoking) and a risk factor count.
- Evaluation of symptom-limited maximal exercise responses, including chest pain, functional aerobic impairment, and heart rate impairment, to create an exercise predictor count.
- Multivariate analysis to identify significant predictors of primary CHD events.
Main Results:
- The annual CHD event rate in hypertensive men (16.9/1000) was significantly higher than in healthy men (3.6/1000).
- Key predictors of CHD events included smoking, risk factor count, chest pain during exercise, functional aerobic impairment, and heart rate impairment.
- Ischemic ST depression was not a significant predictor.
- Both risk factor count and exercise predictor count were independently associated with increased CHD event risk.
- A combined assessment identified groups with substantially different annual event rates, with the highest risk (49.5/1000 man-years) in those with both counts elevated.
Conclusions:
- In hypertensive men, both traditional risk factors and abnormal exercise responses, particularly indicators of left ventricular dysfunction during exertion, significantly predict primary coronary heart disease events.
- A combined risk assessment incorporating both traditional risk factors and exercise-derived parameters provides a more accurate stratification of CHD event risk.
- These findings underscore the importance of comprehensive cardiovascular risk assessment, including exercise testing, in managing hypertensive patients.
Abstract:
Whereas hypertension is a risk factor for primary coronary heart disease events, the relative contributions of other risk factors and abnormal responses to symptom-limited maximal exercise are not well-established. After 5.2 +/- 1.5 years of follow-up of 633 men with clinically-diagnosed hypertension based upon criteria of examining physicians (whether or not the men were currently treated for hypertension), 54 primary events were revealed. The annual coronary heart disease (CHD) event rate of 16.9/1000 men at risk was significantly higher than the annual rate of 3.6/1000 found for healthy men (p < 0.0001). Variables associated with increased risk were smoking cigarettes, risk factor count or tally, chest pain during exercise, percentage of functional aerobic impairment, and percentage heart rate impairment, the latter two variables suggesting early evidence of left ventricular dysfunction on strenuous exertion. Ischemic ST depression was not an important predictor. The three exercise variables were included in an exercise predictor count, and multivariate analysis revealed that this count and the risk factor count were the most important predictors of primary CHD events. Combining the risk factor count and the exercise predictor count, three groups with increasing risk of primary CHD events were identified. In those persons with both a risk factor count and exercise predictor count of zero, the annual rate was 7.3 events/1000 man-years; when either count was one or more, the rate was 15.5 events/1000 man-years; when both counts were one or more, the rate was 49.5 events/1000 man-years.