Original articles

Cardiovascular physiology

Augmented blood pressure response to exercise is associated with improved long-term survival in older people

P Hedberg^1,2, J Öhrvik³, I Lönnberg⁴, G Nilsson²

¹ Department of Clinical Physiology, Central Hospital, Västerås, Sweden
² Center for Clinical Research, Uppsala University, Central Hospital, Västerås, Sweden
³ Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden
⁴ Department of Cardiology, Central Hospital, Västerås, Sweden

Dr P Hedberg, Department of Clinical Physiology, Central Hospital, SE-721 89 Västerås, Sweden; par.o.hedberg{at}ltv.se

Objective: Studies on the prognostic importance of the systolic blood pressure (SBP) response during exercise report ambiguous results. Most research focuses on younger and middle-aged selected patient groups and rarely includes women. We investigated the prognostic value of SBP response during exercise testing in 75-year-olds.

Design: Prospective observational cohort study.

Setting: A community-based random sample of 75-year-old men and women (n = 382).

Main outcome measures: The prognostic value of SBP change from rest to peak exercise during a symptom-limited cycle test was evaluated for the endpoints all-cause mortality and cardiovascular mortality during long-term follow-up.

Results: After a median follow-up of 10.6 years, 140 (37%) of the participants had died, 64 (17%) from cardiovascular causes. The all-cause mortalities for exercise SBP changes of 30 mm Hg, 31–55 mm Hg and >55 mm Hg were 5.1, 4.2 and 2.6 per 100 person-years, respectively (logrank 9.6; p = 0.008). For every 10 mm Hg increase in SBP during exercise the relative hazard for all-cause mortality was reduced by 13% (p = 0.030) and for cardiovascular mortality by 26% (p = 0.004) after adjustment for sex, smoking, waist circumference, total/HDL cholesterol ratio, prevalent ischaemic heart disease, hypertension, diabetes, cardiovascular medication, pre-exercise SBP, exercise capacity, resting left ventricular ejection fraction and left ventricular mass index.

Conclusions: Our findings suggest that an augmented SBP response during exercise is associated with an improved long-term survival among community-living 75-year-old individuals.

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