The prognostic value of post-exercise blood pressure reduction in patients with hypertensive response during exercise stress test

Background: Hypertensive response at peak-exercise and during the recovery phase of exercise stress test (ET) is associated with poor cardiovascular prognosis. We investigated whether decrease in blood pressure (BP) from peak to post-exercise would identify a subgroup at higher cardiovascular risk. Methods: Eighty-six non-hypertensive patients (0-4 cardiovascular risk factors) with hypertensive reaction at peak-ET (systolic > 180 mm Hg and/or diastolic > 100 mm Hg) were divided based on BP 5 min after exercise termination into two groups: Normal response (NrmR) (< 160/90 mm Hg), Hypertensive response (HypR) (≥ 160/90 mm Hg). Five years later the prevalence of cardiovascular risk factors and cardiovascular morbidity and mortality was assessed for each group. Results: Both groups had similar pre- and peak-exercise BP. However the HypR group had higher post-exercise BP (systolic: 163 ± 13 vs. 125 ± 14 mm Hg, respectively, p < 0.01, and diastolic: 74 ± 6 vs. 75 ± 4 mm Hg, respectively, p < 0.01), smaller decrease in BP after exercise (Δ systolic: 46.9 ± 3.1 vs. 73.9 ± 3.6 mm Hg, respectively, p < 0.01, Δ diastolic: 12.4 ± 1.5 vs. 26.5 ± 2.2 mm Hg, respectively, p < 0.01), and higher post- than pre-exercise BP (Δ systolic: 24.5 ± 3.5 vs. - 6 ± 4.1 mm Hg, respectively, p < 0.01, Ä diastolic: 19 ± 2.1 vs. - 13 ± 2.3 mm Hg, respectively, p < 0.01). Five years later, HypR group had higher prevalence of abnormal cholesterol serum level (p < 0.01), hypertension (p < 0.01) and combined ischemic heart disease and cerebrovascular disease (RR 1.32, 95% CI = 1.13-1.54, p < 0.01). Conclusion: During ET evaluation, it is important to evaluate the BP at 5 min after exercise because reduced BP drop, at this routinely measured point, identifies a subgroup with higher cardiovascular risk.