Data from 66 patients ≥ 60 years old with suspected coronary artery disease (CAD) were studied to determine the diagnostic value of an abnormal increase in postexercise systolic blood pressure (SBP) for detecting CAD in gerontal patients. Treadmill exercise testing (TET) and selective coronary angiography (CAG) were carried out and SBP was measured pre-TET and at each minute during a 6-min post-TET recovery phase. Abnormal increase in postexercise SBP was defined as a higher SBP compared with that measured earlier during the 6-min post-TET period. An abnormal increase of ≥ 7 mmHg in postexercise SBP had a statistically significantly better specificity, and also showed higher sensitivity and accuracy, than ST-segment depression ≥ 1 mV in identifying gerontal patients with CAD. The combination of ST-segment depression and abnormal SBP resulted in further improvement of the specificity for detecting CAD. It is concluded that measurement of abnormal increase in postexercise SBP may be a sensitive indicator of gerontal CAD.
GibbonsRJBaladyGJBeasleyJW: ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol1997; 30: 260–311.
FilipovskýJDucimetièrePSafarME: Prognostic significance of exercise blood pressure and heart rate in middle-aged men. Hypertension1992; 20: 333–339.
4.
CurtisJMHortonESBahnsonJ: Prevalence and predictors of abnormal cardiovascular responses to exercise testing among individuals with type 2 diabetes: the Look AHEAD (Action for Health in Diabetes) study. Diabetes Care2010; 33: 901–907.
5.
Bouzas-MosqueraAPeteiroJBroullónFJ: Prognostic value of an exaggerated exercise blood pressure response in patients with diabetes mellitus and known or suspected coronary artery disease. Am J Cardiol2010; 105: 780–785.
6.
PetersonPNMagidDJRossC: Association of exercise capacity on treadmill with future cardiac events in patients referred for exercise testing. Arch Intern Med2008; 168: 174–179.
7.
AmonKWRichardsKLCrawfordMH: Usefulness of the postexercise response of systolic blood pressure in the diagnosis of coronary artery disease. Circulation1984; 70: 951–956.
8.
RomanoMCaiazzoMRDi MaroT: Abnormal recovery systolic blood pressure response for detecting coronary artery disease in men and women investigated by upright bicycle exercise. Acta Cardiol1991; 46: 153–159.
9.
AcanforaDDe CaprioLCuomoS: Diagnostic value of the ratio of recovery systolic blood pressure to peak exercise systolic blood pressure for the detection of coronary artery disease. Circulation1988; 77: 1306–1310.
10.
MiyaharaTYokotaMIwaseM: Mechanism of abnormal postexercise systolic blood pressure response and its diagnostic value in patients with coronary artery disease. Am Heart J1990; 120: 40–49.
11.
TsudaMHatanoKHayashiH: Diagnostic value of postexercise systolic blood pressure response for detecting coronary artery disease in patients with or without hypertension. Am Heart J1993; 125: 718–725.
12.
HashimotoMOkamotoMYamagataT: Abnormal systolic blood pressure response during exercise recovery in patients with angina pectoris. J Am Coll Cardiol1993; 22: 659–664.
13.
AbeKTsudaMHayashiH: Diagnostic usefulness of postexercise systolic blood pressure response for detection of coronary artery disease in patients with electrocardiographic left ventricular hypertrophy. Am J Cardiol1995; 76: 892–895.
14.
TaylorAJBellerGA: Postexercise systolic blood pressure response: clinical application to the assessment of ischemic heart disease. Am Fam Physician1998; 58: 1126–1130.
15.
McHamSAMarwickTHPashkowFJ: Delayed systolic blood pressure recovery after graded exercise: an independent correlate of angiographic coronary disease. J Am Coll Cardiol1999; 34: 754–759.
16.
YamadaKHiraiMAbeK: Diagnostic usefulness of postexercise systolic blood pressure response for detection of coronary artery disease in patients with echocardiographic left ventricular hypertrophy. Can J Cardiol2004; 20: 705–711.
17.
The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med1993; 153: 154–183.
18.
JudkinsMP: Selective coronary arteriography. I. A percutanous transfemoral technic. Radiology1967; 89: 815–824.
GensiniGG: A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol1983; 51: 606.
21.
OvrehusKAJensenJKMickleyHF: Comparison of usefulness of exercise testing versus coronary computed tomographic angiography for evaluation of patients suspected of having coronary artery disease. Am J Cardiol2010; 105: 773–779.
22.
KatoKSaitoFHatanoK: Prognostic value of abnormal postexercise systolic blood pressure response: prehospital discharge test after acute myocardial infarction in Japan. Am Heart J1990; 119: 264–271.
23.
EllisKPothierCEBlackstoneEH: Is systolic blood pressure recovery after exercise a predictor of mortality?Am Heart J2004; 147: 287–292.
24.
HsuJCChuPSSuTC: Predictors for coronary artery disease in patients with paradoxical systolic blood pressure elevation during recovery after graded exercise. Int J Cardiol2007; 119: 274–276.
25.
HuangCLSuTCChenWJ: Usefulness of paradoxical systolic blood pressure increase after exercise as a predictor of cardiovascular mortality. Am J Cardiol2008; 102: 518–523.
26.
EllestadMH: Reliability of blood pressure recordings. Am J Cardiol1989; 63: 983–985.
27.
ChenCYBonhamAC: Postexercise hypotension: central mechanisms. Exerc Sport Sci Res2010; 38: 122–127.
28.
RossowLYanHFahsCA: Postexercise hypotension in an endurance-trained population of men and women following high-intensity interval and steady-state cycling. Am J Hypertens2010; 23: 358–367.
29.
RozanskiAElkayamUBermanDS: Improvement of resting myocardial asynergy with cessation of upright bicycle exercise. Circulation1983; 67: 529–535.
30.
SobueTYokotaMIwaseM: Influence of left ventricular hypertrophy on left ventricular function during dynamic exercise in the presence or absence of coronary artery disease. J Am Coll Cardiol1995; 25: 91–98.
31.
DuilioCSpinelliLLiucciGA: Site of myocardial ischemia as a determinant of postexercise blood pressure and heart rate response in coronary artery disease. Am J Cardiol1993; 72: 1376–1382.
32.
YuZLYangXJGaoMW: Preliminary study of abnormal increase of postexercise systolic blood pressure for detection of coronary artery disease. Chin J Cardiol2004; 33: 44–47 [in Chinese].
