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Elevated systolic blood pressure during recovery from exercise and the risk of sudden cardiac death

Laukkanen, Jari A.a,b; Willeit, Peterc; Kurl, Sudhira; Mäkikallio, Timo H.d; Savonen, Kaie; Ronkainen, Kimmoa; Rauramaa, Rainere

doi: 10.1097/HJH.0000000000000066

Objective: The value of SBP during exercise and recovery period as a risk marker for sudden cardiac death (SCD) is not known. Thus, we assessed the association of SBP during recovery from exercise testing with the risk of SCD.

Methods: SBP was measured every 2 min during and at 2 min after a progressive cycle ergometer exercise in a representative sample of 2366 men (aged 42–61 years). During an average follow-up period of 18.9 years, a total of 180 SCDs occurred.

Results: SBP during recovery from exercise was associated with the risk of SCD (hazard ratio 1.24, 95% confidence interval 1.06–1.45, P = 0.007 for 1 SD increment), after adjustment for age, risk factors and exercise test findings. Men with elevated SBP of over 195 mmHg at 2 min recovery from exercise had a 1.74-fold (95% confidence interval 1.18–2.54, P = 0.005) risk of an SCD as compared to those with SBP less than 170 mmHg, after adjustment for age, risk factors and other exercise test findings. However, after further adjustment for resting SBP, the association between SBP at 2 min recovery from exercise and the risk of SCD became non-significant.

Conclusion: This study shows that SBP during recovery phase from exercise is related to the risk of SCD, although its prognostic value is limited in conjunction with the assessment of resting SBP in the general male population.

aInstitute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio

bLapland Central Hospital, Department of Internal Medicine, Rovaniemi, Finland

cDepartment of Public Health and Primary Care, University of Cambridge, Cambridge, UK

dDivision of Cardiology, Department of Internal Medicine, University of Oulu, Oulu

eKuopio Research Institute of Exercise Medicine, Kuopio and Department of Clinical Physiology and Nuclear Medicine, University Hospital of Kuopio, Kuopio, Finland

Correspondence to Jari A. Laukkanen, MD, PhD, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, P.O. Box 1627, FIN-70211 Kuopio, Finland. Tel: +358 17 162950; fax: +358 17 162936; e-mail:

Abbreviations: CHD, coronary heart disease; SCD, sudden cardiac death

Received 2 August, 2013

Accepted 31 October, 2013

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins