Exercise-induced increase in diastolic pressure: Indicator of severe coronary artery disease

Abstract

The diastolic blood pressure response to treadmill exercise testing was analyzed in 281 patients. Diastolic blood pressure was measured at rest, during each stage of exercise, immediately on recovery, and 1, 3 and 5 minutes into the recovery period. No change or a decrease in diastolic blood pressure was considered a normal response. An increase in diastolic blood pressure of more than 15 mm Hg on at least two determinations, comparing values at rest with those on exercise, was considered an abnormal response. Only patients showing a normal increase in systolic blood pressure during exercise were included. Two hundred and nine patients had a normal and 72 patients an abnormal diastolic blood pressure response. In a subgroup of 41 patients who underwent coronary arteriography, 50 percent of patients with a normal diastolic pressure response had normal coronary arteries, compared with 17 percent of those with an abnormal response ( P < 0.03). Only 11 percent of patients with a normal diastolic pressure response had triple vessel or left main coronary artery disease, compared with 44 percent of patients with an abnormal response ( P < 0.03). Blood pressure at rest ( 132 84 mm Hg ) and peak heart rate (mean 155 beats/min) were similar in each group. There was no significant difference between exercise-induced ischemic S-T segment changes in the two groups (13 percent for patients with a normal diastolic pressure response versus 15 percent for those with an abnormal diastolic pressure response). In conclusion, an abnormal diastolic pressure response to treadmill testing may be a good indicator of coronary artery disease even in the absence of S-T segment changes.