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The exaggerated systolic hypertensive response to exercise predicts cardiovascular events: a systematic review and meta-analysis
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2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 869-869Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Exercise stress testing is mainly used for the assessment of coronary artery disease (CAD), with blood pressure (BP) measurements routinely obtained during the test. In healthy individuals, the increased cardiac output with exercise is associated with perpetual increase in systolic BP (SBP). The pathophysiology of exaggerated hypertensive response to exercise (HRE is not fully understood and the role of HRE in predicting cardiovascular (CV) events is contradictory.

Aim: The aim of this meta-analysis therefore, was to analyze the role of HRE in predicting CV clinical outcomes in healthy normotensive subjects.

Methods: We searched Pubmed-MEDLINE, Cochrane Library, Refworks and Google Scholar aiming to find clinical studies which reported data on CV event rate and outcomes (including mortality) for patients who underwent exercise testing and had HRE. Sensitivity and specificity (with 95% CI) analysis for assessing the diagnostic accuracy of HRE cut-off that predicts CV events was estimated using hierarchical summary receiver operating characteristic analysis.

Results: Eight studies with 47,188 participants were included with a median follow-up duration of 19.3 months. Significantly higher HRE was found in patients with composite events (HR = 1.363 [1.135–1.604]; p<0.001), in those who developed coronary artery events (HR = 1.532 [1.240–1.893]; p<0.001) and CV mortality (HR = 1.286 [1.075–1.539]; p=0.006) compared to normal response patients. An exercise systolic BP of 196 mmHg predicted CV events with sensitivity of 62% (54–69%) and specificity of 75% (60–86%) with positive likelihood ratio (LR+) <3 and strong correlation (r=-0.71).

Conclusion: This meta-analysis supports the clinical relevance of exaggerated blood pressure response to exercise (systolic BP >196 mmHg) as a predictor of composite and CV clinical outcome. These findings should be taken as a thought provoking evidence for finding better stratification of such patients and consequently optimum management for this risky group.

Place, publisher, year, edition, pages
Oxford University Press, 2018. Vol. 39, p. 869-869
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-157617DOI: 10.1093/eurheartj/ehy563.4330ISI: 000459824002745OAI: oai:DiVA.org:umu-157617DiVA, id: diva2:1299359
Conference
European-Society-of-Cardiology Congress, AUG 25-29, 2018, Munich, GERMANY
Note

Supplement: 1

Meeting Abstract: 4330

Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved

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Henein, Michael Y.

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