Blood pressure response during treadmill exercise testing and the risk for future development of atrial fibrillation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Aims Hypertension is a well-established risk factor for the onset and progression of atrial fibrillation (AF). Blood pressure (BP) response during routine exercise stress testing (EST) may identify subjects at increased risk for developing AF. Methods A retrospective analysis of treadmill EST performed by the Bruce protocol in patients aged ≥40 years without a history of AF (n=17,617; 42% women). BP was measured at rest, peak exercise, and 2-minute recovery, and was analyzed for association with the risk for developing AF. Results AF was documented in 4.5% of patients during mean follow-up of 7 years. The incidence rate of AF per 1000 person-years increased with the rise in CHA2DS2VASc score (3.26 in score=0 to 19.78 in scores≥6). Adjusting for CHA2DS2VASc score and exercise capacity, a multivariate analysis of systolic BP at rest (≥130 vs. ≤110 mmHg), peak-exercise (>170 vs. ≤150 mmHg), and recovery (>150 vs. ≤130 mmHg), were associated with increased risk for AF: hazard ratio (HR) 1.68 (95% CI, 1.40-2.01), 1.38 (1.15-1.64), 1.54 (1.27-1.86), respectively. Similarly, diastolic BP analysis at rest (≥90 vs. <80 mmHg), peak-exercise (≥100 vs. <90 mmHg), and recovery (>90 vs. ≤80 mmHg), were associated with increased risk for AF: 1.78 (1.34-2.35), 2.22 (1.37-3.59), 1.73 (0.90-3.25). The association with AF was also observed when BPs were analyzed as continuous variables, including after additional adjustment of exercise and recovery measurements to resting BP. Conclusions Systolic and diastolic BP at rest, peak-exercise and recovery phases of EST may provide independent predictive information regarding future risk for developing AF.