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Augmented blood pressure response to exercise is associated with improved long-term survival in older people
  1. Pär Hedberg (par.o.hedberg{at}
  1. Center of Clinical Research, University of Uppsala, Sweden
    1. John Öhrvik
    1. Cardiology Research Unit, Karolinska Institutet, Sweden
      1. Ingemar Lönnberg
      1. Dept of Cardiology, Sweden
        1. Göran Nilsson
        1. Center of Clinical Research, University of Uppsala, Sweden


          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 mortality rates for exercise SBP changes of <= 30 mmHg, 31-55 mmHg, and > 55 mmHg were 5.1, 4.2, and 2.6 per 100 person-years, respectively (log rank 9.6; p = 0.008). For every 10 mmHg 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 ischemic 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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