Variable prognostic value of blood pressure response to exercise

Abstract

The role of BP response to exercise as the predictor depends on exercise capacity of each patient.

2018 ESC/ESH Guidelines for the management of arterial hypertension

“…As discussed above, HMOD assessment may play a role in stratifying the risk of patients with hypertension. In posthoc analyses, BP treatment-induced regression of some (but not all) manifestations of asymptomatic HMOD, as a consequence of treatment, is associated with a reduction in cardiovascular risk, thereby providing additional information on the effectiveness of treatment in individual patients [16,104,171]. This has been best illustrated for the treatmentinduced regression of LVH measured by either ECG or echocardiography [125,172,173].…”

Research update for articles published in EJCI in 2016

“…72 Nonetheless, this negative association, also confirmed in another study on a Japanese population, 73 might depend on peak VO2, such that the prognostic value of blood pressure response might be limited in patients with preserved exercise capacity. 73 In addition, a hypertensive response with exercise (defined as a systolic blood pressure ≥220 mm Hg during the test) has also been associated with lower risk of echocardiographic myocardial ischaemia.…”

“…The association of an excessive blood pressure increase with exercise (ie, an increase in systolic blood pressure with exercise ≥95th percentile) with lower risk of subsequent events 71 in patients with known or suspected coronary artery disease has been consistently verified even in those with baseline hypertension. 72 Nonetheless, this negative association, also confirmed in another study on a Japanese population, 73 might depend on peak VO2, such that the prognostic value of blood pressure response might be limited in patients with preserved exercise capacity. 73 In addition, a hypertensive response with exercise (defined as a systolic blood pressure ≥220 mm Hg during the test) has also been associated with lower risk of echocardiographic myocardial ischaemia.…”

“…72 Nonetheless, this negative association, also confirmed in another study on a Japanese population, 73 might depend on peak VO2, such that the prognostic value of blood pressure response might be limited in patients with preserved exercise capacity. 73 In addition, a hypertensive response with exercise (defined as a systolic blood pressure ≥220 mm Hg during the test) has also been associated with lower risk of echocardiographic myocardial ischaemia. 74 These findings might be mediated mainly by the degree of exercise-induced increase in cardiac output, which is a main determinant of blood pressure response and may be blunted or even reversed in the presence of significant coronary artery disease.…”

2018 ESC/ESH Guidelines for the management of arterial hypertension

“…In post hoc analyses, BP treatment-induced regression of some (but not all) manifestations of asymptomatic HMOD, as a consequence of treatment, is associated with a reduction in CV risk, thereby providing additional information on the effectiveness of treatment in individual patients. 16,104,171 This has been best illustrated for the treatment-induced regression of LVH measured by either ECG or echocardiography. 125,172,173 A reduced incidence of CV events and slower progression of renal disease has been reported with a treatment-induced reduction in urinary protein excretion in both diabetic and non-diabetic patients, especially for microalbuminuria, 174 but results are discordant.…”