Abstract 9882: Post-Exercise Blood Pressure Predicts Future Cardiovascular Mortality in Asymptomatic Individuals

Abstract

Background: Non-electrocardiographic parameters obtained from exercise testing, including exercise capacity, exercise blood pressure, chronotropic response, and heart rate recovery, are clinically useful in determining prognosis in asymptomatic individuals. We hypothesized a relationship between post-exercise blood pressure (BP) and CVD mortality. Methods and results: After performing submaximal Bruce treadmill tests, a total of 6,451 asymptomatic North American study participants (56% males, mean age 44) from the Lipid Research Clinic Prevalence Study were prospectively followed for 20 years (366 CVD deaths). Post-exercise BP was the measured BP taken after ceasing exercise for 2 min, 4 min, and 6 min for systolic (SBP) and diastolic (DBP). The association of CVD mortality was stronger for post-exercise SBP (4 min age- and sex-adjusted hazard ratio 1.42 [95% CI, 1.28-1.55] per 1-SD increment [21 mmHg]) than post-exercise DBP (1.26 [1.14-1.38] per 1-SD increment [12 mm Hg]). After multivariate adjustment, post-exercise DBP was not associated with CVD mortality. By contrast, post-exercise 2 min, 4 min, and 6 min SBP were each positively associated with CVD mortality, with the post-exercise 4 min SBP having the greatest magnitude of risk. After adjusting for standard risk factors, baseline BP, heart rate recovery, and exercise capacity, the adjusted hazard ratios (95% CIs) for increasing quartiles of post-exercise 4 min SBP were 1.00 (reference), 1.47 (0.94-2.31), 1.75 (1.15-2.66) and 2.21 (1.43-3.43), p for trend<0.001 (Table). Conclusion: Elevated post-exercise SBP was significantly associated with CVD mortality in asymptomatic individuals independent of other risk factors, including baseline BP. A post-exercise 4 min SBP greater than 150 mmHg identifies higher risk individuals who may warrant more aggressive treatment than is currently recommended.