There is increasing evidence regarding exercise blood pressure as a predictor for later cardiovascular disease in apparently healthy individuals. We aimed to investigate the association between exercise systolic blood pressure and risk of coronary heart disease (CHD) in healthy men after two consecutive bicycle exercise tests seven years apart.
1999 presumably healthy men underwent thorough medical examination and where considered free of any chronic disease or long-term pharmacological treatment. After seven years, 1392 men were still considered healthy after the same examination, and able to complete a six-minute bicycle exercise test at 100 W workload at both visits. Exercise blood pressure was measured auscultatory at both visits, at rest and every two minutes during the test. Peak measurement during the test at the second visit was used in a Cox regression analysis, adjusted for age, systolic blood pressure at rest at first visit, serum cholesterol, smoking status, family history of CHD and physical fitness. Participants were divided in quartiles of peak systolic blood pressure at 100 W (Q1: 100–160mmHg, Q2: 165–175 mmHg, Q3: 180–195 mmHg, Q4: >/= 200 mmHg), and followed for up to 28 years after the second visit.
There were 452 events of the combined endpoint of angina pectoris, non-fatal myocardial infarction and CHD mortality. Unadjusted, there was a significant increase in risk of CHD with increasing exercise systolic blood pressure (figure). In the multiple-adjusted analysis, there was a significantly increased risk of CHD in both Q3 and Q4 compared to Q1, hazard ratios (95 % confidence interval, p-value) 1.33 (1.00–1.78, 0.05) and 1.70 (1.24–2.35, 0.001), respectively.
There is increased long-term risk of coronary heart disease with blood pressure above 180 mmHg at moderate workload during bicycle exercise in middle-aged Caucasian men who were healthy during a seven-year period. The results are consistent after adjustment for the classical cardiovascular risk factors, family history of CHD and physical fitness.
1Department of Emergency Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
2Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
3Insitute of Clinical Medicine, University of Oslo, Oslo, Norway
4Institute of Informatics, University of Oslo, Oslo, Norway
5Insitute of Clinical Medicine; University of Tromsø, Tromsø, Norway