Circulation, Vol 78, 1380-1387, Copyright © 1988 by American Heart Association
P Dubach, VF Froelicher, J Klein, D Oakes, M Grover-McKay and R Friis
The objective of this study was to demonstrate the causes, optimal
definition, and predictive value of exercise-induced hypotension occurring
during treadmill testing. This study included all patients referred for
clinical reasons to the Long Beach Veterans Administration Medical Center
treadmill laboratory and then followed for a 2-year period for cardiac
events. The population consisted of 2,036 patients who underwent testing
from April 4, 1984, to May 7, 1987, 131 of whom exhibited exercise-induced
hypotension (6.4%). We found that exercise- induced hypotension is usually
related to myocardial ischemia or myocardial infarction, is best defined as
a drop in systolic blood pressure during exercise below the standing
preexercise value, and indicates a significantly increased risk for cardiac
events (3.2-fold, p less than 0.005). This increased risk was not found in
those having no previous myocardial infarction or no signs or symptoms of
ischemia during the exercise test, and the increased risk was also not
found in those undergoing a treadmill test within 3 weeks after a
myocardial infarction. Exercise-induced hypotension appeared to be reversed
by revascularization procedures, but confirmation of a beneficial effect on
survival requires a randomized trial. The clinical importance of this study
is that we have demonstrated that a drop in systolic blood pressure below
standing preexercise values during treadmill testing indicates an increased
risk for cardiac events except in certain subsets of patients.
ARTICLES
Exercise-induced hypotension in a male population. Criteria, causes, and prognosis
Long Beach Veterans Administration Medical Center, CA 90822.
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