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Vol. 220. Issue 4.
Pages 228-235 (May 2020)
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Vol. 220. Issue 4.
Pages 228-235 (May 2020)
Original article
An exaggerated increase in blood pressure with exercise does not predict mortality or severe cardiovascular events in women referred for exercise echocardiography for clinical reasons
Un incremento exagerado de la presión arterial con el ejercicio no predice mortalidad ni eventos cardiovasculares graves en mujeres referidas a ecocardiografía de ejercicio por razones clínicas
M.C. Bouzas-Mosqueraa,
Corresponding author
carmen.bouzas@uclm.es

Corresponding author.
, A. Bouzas Mosquerab, J. Peteirob, B. Espina-Jerezc, P. Domínguez-Isabelc, S. Gómez Cantarinoa
a Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha, Toledo, Spain
b Departamento de Cardiología, Complexo Hospitalario Universitario de A Coruña, La Coruña, Spain
c Universidad de Castilla la Mancha, Toledo, Spain
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Figures (1)
Tables (4)
Table 1. Patient baseline characteristics according to the onset of exaggerated systolic blood pressure increase with exercise.
Table 2. Results of exercise echocardiography according to the onset of exaggerated systolic blood pressure increase with exercise.
Table 3. Univariate predictors of cardiovascular events in the follow-up.
Table 4. Multivariate predictors of mortality and cardiovascular events.
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Abstract
Background and objectives

The association between an exaggerated systolic blood pressure increase with exercise (EBPIE) and the probability of cardiovascular events is controversial and poorly studied in the female population. Our aim was to determine the possible association between EBPIE on one hand and mortality and cardiovascular events on the other in women referred for exercise echocardiography due to known or suspected coronary artery disease.

Patients and methods

A total of 3942 women with known or suspected coronary artery disease underwent exercise echocardiography. We defined EBPIE as a ≥70mmHg increase in systolic blood pressure with exercise. The study endpoints were overall and cardiac mortality, acute myocardial infarction (MI), stroke and coronary revascularisation procedures.

Results

A total of 332 women developed EBPIE during the test. During the follow-up, 458 deaths (162 of cardiac origin), 212 MIs, 89 strokes and 345 coronary revascularisation procedures were recorded. The annual rates of overall and cardiac mortality were lower in the patient subgroup with EBPIE (0.15% vs. 2.3%, p=.02 and 0.01% vs. 0.2%, p=.015, respectively). There were no significant differences in the rates of MI, stroke and the need for coronary revascularisation procedures, which occurred in 1.1%, 0.43% and 2.24% of the patients with EBPIE, respectively, and occurred in 0.09%, 0.05% and 0.13% of the women without EBPIE (p=.66; p=.57; p=.19, respectively). After a multivariate adjustment, EBPIE was not a predictor of mortality or cardiovascular events.

Conclusions

EBPIE is not associated with mortality or severe cardiovascular events in women with known or suspected coronary artery disease.

Keywords:
Exercise
Hypertensive response
Prognosis
Women
Resumen
Fundamento y objetivos

La asociación entre un incremento exagerado de la presión arterial sistólica con el ejercicio (IEPASE) y la probabilidad de eventos cardiovasculares es controvertida y poco estudiada en población femenina. Nuestro propósito fue determinar la posible asociación de un IEPASE con mortalidad y eventos cardiovasculares en mujeres referidas a ecocardiografía de ejercicio por enfermedad coronaria conocida o sospechada.

Pacientes y métodos

Se realizó ecocardiografía de ejercicio a 3.942 mujeres con enfermedad coronaria conocida o sospechada. El IEPASE se definió como un incremento de la presión arterial sistólica con el ejercicio ≥70mmHg. Los objetivos fueron mortalidad global y cardíaca, infarto agudo de miocardio (IM), accidente cerebrovascular (ACV) e intervenciones de revascularización coronaria.

Resultados

Trescientas treinta y dos mujeres desarrollaron IEPASE durante los test. En el seguimiento se registraron un total de 458 muertes (162 de origen cardíaco), 212 IM, 89 ACV y 345 intervenciones de revascularización coronaria. La tasa anual de mortalidad global y cardiaca fue inferior en el subgrupo de pacientes con IEPASE (0,15% vs. 2,3%, p=0,02 y 0,01% vs. 0,2%, p=0,015, respectivamente). No observamos diferencias significativas en las tasas de IM, ACV y de intervenciones de revascularización coronaria, que fueron, respectivamente, del 1,1%, 0,43% y 2,24% en pacientes con IEPASE y del 0,09%, 0,05% y 0,13% en aquellas mujeres sin IEPASE (p=0,66; p=0,57; p=0,19, respectivamente), Tras un ajuste multivariante el IEPASE no resultó predictor de mortalidad ni de eventos cardiovasculares.

Conclusiones

El IEPASE no se asoció con mortalidad ni eventos cardiovasculares graves en mujeres con enfermedad coronaria conocida o sospechada.

Palabras clave:
Ejercicio
Respuesta hipertensiva
Pronóstico
Mujeres

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