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SBP above 180 mmHg at moderate exercise workload increases coronary heart disease risk in healthy men during 28-year follow-up

Mariampillai, Julian E.a; Prestgaard, Erik E.a,b; Kjeldsen, Sverre E.a,b; Liestøl, Knutc; Engeseth, Kristiana,b; Erikssen, Janb; Bodegard, Johana; Berge, Eivinda,d; Grundvold, Irenea; Skretteberg, Per T.a

doi: 10.1097/HJH.0000000000001959
ORIGINAL PAPERS: Epidemiology
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Objective: We investigated the association between exercise SBP at a moderate workload and long-term risk of coronary heart disease (CHD) in men who were healthy when assessed by two bicycle exercise tests 7 years apart.

Methods: During 1972–1975, apparently healthy men (n = 1999) were initially enrolled following thorough medical examination and ECG-monitored bicycle exercise test. Participants (n = 1392) who were healthy also at a second exercise test 7 years later were included in the present study. They were divided into quartiles, Q1–Q4, according to the highest SBP during the initial 6 min of the exercise test on a moderate workload of 100 W (SBP100W) at 7 years and followed for up to 28 years. Adjusted Cox regression was used to estimate CHD risk defined as first occurrence of angina pectoris, nonfatal myocardial infarction or CHD mortality.

Results: During follow-up, 452 of the 1392 men suffered incident CHD, and unadjusted, there was increased risk of CHD with increasing SBP100 W, with significant differences between Q1–Q4. In the multivariate analysis adjusting for classical coronary risk factors, including SBP at rest, there was increased risk of CHD in Q3 (SBP100 W above 180 mmHg) and Q4 (SBP100 W above 200 mmHg) compared with Q1 (≤160 mmHg, lowest SBP100 W), hazard ratios 1.42 (CI 1.07–1.90) and 1.93 (CI 1.38–2.70), respectively.

Conclusion: Healthy middle-aged men had increased long-term risk of CHD with exercise SBP above 180 mmHg at moderate workload. The prognostic impact of SBP above 180 mmHg at exercise is independent of classical coronary risk factors and blood pressure at rest.

aDepartment of Cardiology, Oslo University Hospital, Ullevaal

bInsitute of Clinical Medicine

cInstitute of Informatics, University of Oslo, Oslo

dInstitute of Clinical Medicine, University of Tromsø, Tromsø, Norway

Correspondence to Prof Sverre E. Kjeldsen, Department of Cardiology, Oslo University Hospital, Ullevaal, Kirkeveien 166, NO-0450 Oslo, Norway. E-mail: s.e.kjeldsen@medisin.uio.no

Abbreviations: CHD, coronary heart disease; CI, 95% confidence interval; CVD, cardiovascular disease; Q1, quartile 1; Q2, quartile 2; Q3, quartile 3; Q4, quartile 4; SBP100 W, peak SBP during initial 6 minutes of the exercise test

Received 20 July, 2018

Accepted 10 September, 2018

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