Diagnostic value of postexercise systolic blood pressure response for detecting coronary artery disease in patients with or without hypertension

Abstract

To evaluate the diagnostic value of the postexercise systolic blood pressure (SBP) response for detecting and evaluating the presence of coronary artery disease (CAD), treadmill testing was conducted in 130 subjects with normal blood pressure and 51 patients with hypertension, each of whom underwent selective coronary angiography. A total of 48 subjects with normal blood pressure and 27 patients with hypertension had no significant narrowing of the coronary artery (control subjects), whereas 82 subjects with normal blood pressure and 24 patients with hypertension had significant narrowing (patients with CAD). The postexercise SBP response was defined on the basis of the SBP ratio (i.e., the SBP at a minutes of recovery divided by that at peak exercise). An SBP ratio that exceeded 0.90 (cutoff point for discriminating control subjects from patients with CAD) was considered to be an abnormal SBP response. In the subjects with normal blood pressure, the abnormal SBP response identified CAD as accurately as did ST-segment depression. In the patients with hypertension, the diagnostic accuracy was increased significantly by combining the abnormal SBP response and ST-segment depression (p < 0.01). The SBP ratio increased with the number of diseased coronary arteries. Ten of the 14 patients with a narrowing of the left main coronary artery had an SBP ratio higher than 1.00. The postexercise SBP response may be useful for detecting CAD in patients with and without hypertension and for evaluating the severity of CAD.