PURPOSE: Systolic blood pressure (SBP) is often related to age. This study evaluated whether the exercise related change in SBP is a prognostic factor for CV mortality in elderly patients. METHODS: The study group included 2071 male veterans older than 65 years referred for ETT at 2 university hospitals. SBP before, during and after the test was recorded manually. Patients were divided into two groups: Group A: Ex-induced increase in SBP ≤ 40 mm Hg (n= 1167) and Group B: Ex-induced increase in SBP ≥ 40 mm Hg (n=904). Patients were followed (mean follow up of 6.2 +/− 3.7years), using CV mortality as the end-point. RESULTS: Patients in Group A were significantly older (71 vs 70 P<0.001), had higher use of beta blockers (BB), history of MI(p<0.001), CHF (p<0.01), a sig. higher resting SBP [(142 vs134 mm Hg) (p<.001)], a sig. lower peak HR response to exercise [(123 vs 135) (p<0.001)], higher incidence of exercise induced ST abnormalities (21% vs 12% p value <0.001) lower maximum SBP (163 vs 196 p value <0.001) and METs achieved [(4.9 vs 5.4) (p<0.001)] than group B. There were 333 CV deaths over the follow-up period, with a sig. greater proportion of deaths in Group A [n=213(10.3%)] than Group B [n= 120(5.8%)], (p < 0.0001). Cox proportional hazard regression (adjusting for age, BB use, history of MI, CHF, resting HR and SBP, METs and ST abnormalities during ETT) showed that exercise induced increase in SBP ≤ 40 mm Hg was not a sig. predictor of CV mortality in this population. CONCLUSIONS: The change in SBP with ex testing is not an independent prognostic factor as compared to METs and ST abnormalities for CV mortality over long-term follow-up.Table