Significance of exertional hypotension in apparently healthy men: An 8.9-year follow-up

A multistage submaximal exercise test was performed on 1347 apparently healthy men aged 39.8 ± 4 years. Of these, 49 showed a hypotensive response which was defined as a failure of systolic blood pressure (SBP) to rise during exercise by > 20 mmHg above the resting value, or a fall of 10 mmHg when compared with the previous workloads. An aged-matched group of 200 healthy men with a normal blood pressure response to exercise, was selected for the control group. Excluding 13 of the hypotensive group and 52 of the controls who were lost to follow-up, all subjects were retested after 4 years and again after 8.9 years. After 4 years, no significant changes from baseline were found in symptoms or in clinical findings. After 8.9 years, however, the following was noted: (A) exercise induced ST segment horizontal depression of > 1 mm was observed in 4/36 (11.1%) of the hypotensive group, and 5/148 (3.4%) of the control group; (B) 3/4 in the hypotensive group, and 3/5 in the control group with exercise induced ST changes of > 1 mm, had typical stable angina pectoris; (C) two men from the hypotensive group and none in the control group had a transmural myocardial infarction. The results suggested that a hypotensive SBP response to multistage exercise may be an additional indicator of early coronary disease in symptom free healthy individuals.