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Effects of β-Blockers on Maximal Heart Rate Prediction Equations in a Cardiac Population

Godlasky, Elizabeth MS; Hoffman, Trisha MS; Weber-Peters, Sonya MS; Bradford, Richard MS; Miller, Nathan MS; Kunselman, Allen R. MA; Lott, Mary E. J. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: March 2018 - Volume 38 - Issue 2 - p 111–117
doi: 10.1097/HCR.0000000000000328
Exercise Physiology

Purpose: To derive specific maximal heart rate (HRmax) prediction equations for a coronary artery disease (CAD) population based upon status of β-blocker (BB) therapy and to compare these to prior HRmax equations (Fox and Brawner-specific for CAD).

Methods: We retrospectively reviewed stress echocardiogram treadmill tests in patients with CAD, dividing subjects into 3 groups based upon BB use on test day: not prescribed BB therapy (no BB group; n = 110); held for 12 to 24 hr prior (held BB group; n = 155); and continued taking (took BB group; n = 72).

Results: Derived HRmax equations for our CAD population were no BB = 200 − 0.79 × age; held BB = 193 − 0.71 × age; and took BB = 168 − 0.51 × age. Achieved HRmax mean was not significantly different between held BB and no BB groups; however, HRmax in the took BB group was significantly lower. Fox and Brawner (no BB)-HRmax equations significantly overestimated (+6 and +9 mean bias) and underestimated (−8 and −6 mean bias) achieved HRmax in no BB and held BB groups, respectively. The Brawner (no BB) equation intercept and slope were not significantly different from our CAD-held BB and no BB equations. The Brawner (on BB) equation intercept and slope were similar to our took BB equation, but greatly underestimated achieved HRmax (−17 mean bias).

Conclusion: For patients holding BB therapy on test day, a similar CAD HRmax estimation equation to those patients never on BB can be used, comparable to the Brawner (no BB) equation. Further research is needed to determine when patients should take their BB therapy in conjunction with exercise testing.

We derived maximal exercise heart rate (HRmax) prediction equations for patients with coronary artery disease based upon β-blocker (BB) use. For patients holding BBs on test day, an HRmax estimation equation, similar to those patients never on BBs, can be used, which is comparable to the Brawner (no BB)-HRmax equation.

The Penn State University Milton S. Hershey Medical Center, Heart and Vascular Institute, Hershey, Pennsylvania (Mss Godlasky, Hoffman, and Weber-Peters, Messrs Bradford and Miller, and Dr Lott); and Public Health Sciences, Penn State University Hershey, Pennsylvania (Mr Kunselman).

Correspondence: Nathan Miller, MS, The Penn State University Milton S. Hershey Medical Center, Heart and Vascular Institute, 500 University Dr, Mail Code H150, Hershey, PA 17083 (

All authors have read and approved of the article.

The authors declare no conflicts of interest.

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