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Vol. 218. Num. 1.January - February 2018
Pages 1-48
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Vol. 218. Num. 1.January - February 2018
Pages 1-48
Original article
DOI: 10.1016/j.rceng.2017.07.001
Exaggerated hypertensive response to exercise and myocardial ischemia in patients with known or suspected coronary artery disease
Respuesta hipertensiva exagerada al ejercicio e isquemia miocárdica en pacientes con enfermedad coronaria conocida o sospechada
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C. Bouzas-Mosqueraa,
Corresponding author
, A. Bouzas-Mosquerab, J. Peteirob
a Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
b Unidad de Imagen y Función Cardíacas, Servicio de Cardiología, Hospital Universitario A Coruña, A Coruña, Spain
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Tables (4)
Table 1. Patient baseline characteristics according to the development of an exaggerated hypertensive response to exercise.
Table 2. Results of the exercise echocardiography according to the onset of an exaggerated hypertensive response to exercise.
Table 3. Predictors of exaggerated hypertensive response to exercise.
Table 4. Adjusted effect of the exaggerated hypertensive response to exercise in the development of exercise-induced myocardial ischemia.
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Abstract
Objectives

The association between an exaggerated hypertensive response to exercise (EHRE) and the probability of ischemia in stress tests is controversial. Our purpose was to determine the possible association between an EHRE and the development of chest pain and electrocardiographic or echocardiographic ischemia with exercise.

Patients and methods

A retrospective observational study was conducted of 10,047 patients with known or suspected coronary artery disease referred for exercise echocardiography. A logistic regression analysis assessed the effect of developing an EHRE (defined as a maximum systolic blood pressure with exercise ≥220mmHg) and the onset of chest pain and electrocardiographic and echocardiographic changes suggestive of ischemia.

Results

A total of 402 patients developed an EHRE. The rates of angina, electrocardiographic ischemia and echocardiographic ischemia among the patients with an EHRE were 8.2, 16.2 and 22.6% versus 13.8, 14.7 and 27.5%, respectively, for patients without an EHRE (p=.001, p=.4, p=.032). After a multivariate fit, EHRE was associated with a lower probability of exercise-induced angina (OR, 0.44; 95% CI 0.30–0.65; p<.001) and echocardiographic ischemia (OR, 0.63; 95% CI 0.48–0.83; p=.001) but not with the onset of electrocardiographic ischemia.

Conclusions

EHRE is associated with a lower prevalence of angina and echocardiographic ischemia in patients with known or suspected coronary artery disease.

Keywords:
Exercise
Hypertensive response
Ischemia
False positives
Resumen
Objetivos

La asociación entre una respuesta hipertensiva exagerada al ejercicio (RHEE) y la probabilidad de isquemia en las pruebas de esfuerzo es controvertida. Nuestro propósito fue determinar la posible asociación entre una RHEE y el desarrollo de dolor torácico y de isquemia electrocardiográfica o ecocardiográfica con el ejercicio.

Pacientes y métodos

Estudio retrospectivo y observacional de 10.047 pacientes con enfermedad coronaria conocida o sospechada referidos para una ecocardiografía de ejercicio. Un análisis de regresión logística evaluó el efecto del desarrollo de una RHEE (definida como una presión arterial sistólica máxima con el ejercicio ≥ 220mmHg) y la aparición de dolor torácico y de cambios electrocardiográficos y ecocardiográficos sugestivos de isquemia.

Resultados

Un total de 402 pacientes desarrollaron una RHEE. Los porcentajes de dolor torácico anginoso, isquemia electrocardiográfica y ecocardiográfica entre los pacientes con RHEE fueron del 8,2, 16,2 y 22,6%, frente al 13,8, 14,7 y 27,5%, respectivamente, en pacientes sin RHEE (p=0,001, p=0,4, p=0,032). Tras un ajuste multivariado, la RHEE se asoció con una menor probabilidad de aparición de dolor torácico anginoso inducido por el esfuerzo (OR 0,44; IC 95% 0,30-0,65; p<0,001) y de isquemia ecocardiográfica (OR 0,63; IC 95% 0,48-0,83; p=0,001), pero no con el desarrollo de isquemia electrocardiográfica.

Conclusiones

La RHEE se asocia con una menor prevalencia de dolor torácico anginoso e isquemia ecocardiográfica en pacientes con enfermedad coronaria conocida o sospechada.

Palabras clave:
Ejercicio
Respuesta hipertensiva
Isquemia
Falsos positivos

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