Peak Systolic Blood Pressure in Exercise Testing is Associated With Scintigraphic Severity of Myocardial Ischemia in Patients With Exercise-Induced ST-Segment Depression

``The chapter Blood Pressure Measurement During Exercise reviews the 3 methods of sphygmomanometry to measure blood pressure and normal and abnormal blood pressure responses to exercise. Mercury, aneroid, and oscillometric assessment of Korotkoff sounds provide accurate measurement. Periodic calibration is important for aneroid and oscillometric devices. With verification, automated oscillometric measurements during exercise can be accurate. The normal blood pressure response to exercise testing is an incremental increase in systolic blood pressure with minimal change in diastolic blood pressure. Exercise induced hypotension, particularly early in exercise, is predictive of severe coronary artery disease (CAD). Its occurrence at peak exercise at a high level of exertion may occur in normal individuals secondary to exhaustion. An exaggerated systolic response to exercise is modestly predictive of future hypertension. A slow decrease is systolic blood pressure during recovery is suggestive of CAD, likely secondary to less vagal tone, analogous to a slow decrease in heart rate during recovery.

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Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality

European Journal of Preventive Cardiology ◽

10.1177/2047487319877268 ◽

2019 ◽

Vol 27 (9) ◽

pp. 978-987 ◽

Cited By ~ 4

Author(s):

Kristofer Hedman ◽

Nicholas Cauwenberghs ◽

Jeffrey W Christle ◽

Tatiana Kuznetsova ◽

Francois Haddad ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Exercise Testing ◽

Lower Risk ◽

Metabolic Equivalents ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Clinical Exercise Testing

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 (<210 mmHg) and higher SBP/MET-slope (>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 > 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.

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Features of ST segment and T-wave in exercise-induced myocardial ischemia evaluated with multichannel magnetocardiography

Annals of Medicine ◽

10.1080/07853890252953518 ◽

2002 ◽

Vol 34 (2) ◽

pp. 120-129 ◽

Cited By ~ 23

Author(s):

Helena Hänninen ◽

Panu Takala ◽

Petri Korhonen ◽

Lasse Oikarinen ◽

Markku Mäkijärvi ◽

...

Keyword(s):

Myocardial Ischemia ◽

T Wave ◽

St Segment ◽

Exercise Induced

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Parameters to Be Measured during Exercise

Ellestad's Stress Testing ◽

10.1093/med/9780190225483.003.0005 ◽

2018 ◽

pp. 82-105

Author(s):

Gregory S. Thomas ◽

Myrvin H. Ellestad

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Myocardial Ischemia ◽

Oxygen Uptake ◽

Exercise Duration ◽

Metabolic Equivalents ◽

Include Blood Pressure ◽

Electrocardiographic Changes ◽

Health And Disease ◽

Exercise Induced

The chapter Parameters to be Measured During Exercise reviews the physiologic changes with exercise which indicate health and disease. Key parameters include blood pressure, heart rate, electrocardiographic changes, exercise duration, maximum oxygen uptake (VO2max), and anaerobic threshold. An in-depth review and consensus estimate is provided to estimate metabolic equivalents (METs) achieved based on exercise duration on the Bruce and Ellestad protocols. Use of bipolar leads for detection of exercise induced myocardial ischemia is discussed, typified by CM5 which captures up to 90% of patients with an electrocardiographic manifestation of ischemia. Changes in murmurs that occur with exercise are reviewed; walk-through angina and chronotropic incompetence.

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Comparative β-Adrenoreceptor-Blocking Effects and Pharmacokinetics of Propranolol and Pindolol in Hypertensive Africans

Clinical Science ◽

10.1042/cs057393s ◽

1979 ◽

Vol 57 (s5) ◽

pp. 393s-396s ◽

Cited By ~ 4

Author(s):

L. A. Salako ◽

A. O. Falase ◽

A. Fadeke Aderounmu

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Diastolic Pressure ◽

Exercise Heart Rate ◽

Double Blind ◽

Blocking Effects ◽

The Mean ◽

Exercise Induced ◽

African Patients

1. The β-adrenoreceptor-blocking effects of pindolol were compared with those of propranolol and a placebo in a double-blind cross-over trial involving nine hypertensive African patients. 2. Heart rate, systolic blood pressure and diastolic blood pressure were measured at rest and immediately after exercise before and at intervals up to 6 h after oral administration of the drugs. In addition, plasma pindolol and propranolol concentrations were determined at the same intervals. 3. Pindolol diminished systolic blood pressure at rest and after exercise and antagonized exercise-induced tachycardia, but had no effect on resting heart rate. Propranolol diminished systolic blood pressure predominantly after exercise and reduced both resting and exercise heart rate. Both drugs had no effect on diastolic pressure. 4. The mean plasma concentration reached a peak at 2 h for each drug and this coincided with the interval at which maximal β-adrenoreceptor-blocking effect was observed.

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