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Peak exercise SBP and future risk of cardiovascular disease and mortality

Hedman, Kristofer ; Lindow, Thomas ; Cauwenberghs, Nicholas ; Carlén, Anna ; Elmberg, Viktor LU orcid ; Brudin, Lars and Ekström, Magnus LU orcid (2022) In Journal of Hypertension 40(2). p.300-309
Abstract

Objectives: This study aimed to evaluate the risk of all-cause mortality and incident cardiovascular disease associated with peak systolic blood pressure (PeakSBP) at clinical exercise testing. Methods: Data from 10096 clinical exercise tests (54% men, age 18—85 years) was cross-linked with outcome data from national registries. PeakSBP was compared with recently published reference percentiles as well as expressed as percentage predicted PeakSBP using reference equations. Natural cubic spline modelling and Cox regression were used to analyse data stratified by sex and baseline cardiovascular risk profile. Results: Median [IQR] follow-up times were 7.9 [5.7] years (all-cause mortality) and 5.6 [5.9] years (incident cardiovascular... (More)

Objectives: This study aimed to evaluate the risk of all-cause mortality and incident cardiovascular disease associated with peak systolic blood pressure (PeakSBP) at clinical exercise testing. Methods: Data from 10096 clinical exercise tests (54% men, age 18—85 years) was cross-linked with outcome data from national registries. PeakSBP was compared with recently published reference percentiles as well as expressed as percentage predicted PeakSBP using reference equations. Natural cubic spline modelling and Cox regression were used to analyse data stratified by sex and baseline cardiovascular risk profile. Results: Median [IQR] follow-up times were 7.9 [5.7] years (all-cause mortality) and 5.6 [5.9] years (incident cardiovascular disease), respectively. The adjusted risk of all-cause mortality [hazard ratio, 95% confidence interval (95% CI)] for individuals with PeakSBP below the 10th percentile was 2.00 (1.59–2.52) in men and 2.60 (1.97–3.44) in women, compared with individuals within the 10th–90th percentile. The corresponding risk for incident cardiovascular disease was 1.55 (1.28–1.89, men) and 1.34 (1.05–1.71, women). For males in the upper 90th percentile, compared with individuals within the 10th–90th percentile, the adjusted risks of all-cause death and incident cardiovascular disease were 0.35 (0.22–0.54) and 0.72 (0.57–0.92), respectively, while not statistically significant in women. Spline modelling revealed a continuous increase in risk with PeakSBP values less than 100% of predicted in both sexes, with no increase in risk more than 100% of predicted. Conclusion: Low, but not high, PeakSBP was associated with an increased risk of mortality and future cardiovascular disease. Using reference standards for PeakSBP could facilitate clinical risk stratification across patients of varying sex, age and exercise capacity.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Blood pressure, Epidemiology, Exercise testing
in
Journal of Hypertension
volume
40
issue
2
pages
10 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:34475344
  • scopus:85123306321
ISSN
0263-6352
DOI
10.1097/HJH.0000000000003008
language
English
LU publication?
yes
id
f4689b18-b34f-4f47-87d9-1dfe7892046b
date added to LUP
2022-03-18 15:02:40
date last changed
2024-05-16 08:51:55
@article{f4689b18-b34f-4f47-87d9-1dfe7892046b,
  abstract     = {{<p>Objectives: This study aimed to evaluate the risk of all-cause mortality and incident cardiovascular disease associated with peak systolic blood pressure (PeakSBP) at clinical exercise testing. Methods: Data from 10096 clinical exercise tests (54% men, age 18—85 years) was cross-linked with outcome data from national registries. PeakSBP was compared with recently published reference percentiles as well as expressed as percentage predicted PeakSBP using reference equations. Natural cubic spline modelling and Cox regression were used to analyse data stratified by sex and baseline cardiovascular risk profile. Results: Median [IQR] follow-up times were 7.9 [5.7] years (all-cause mortality) and 5.6 [5.9] years (incident cardiovascular disease), respectively. The adjusted risk of all-cause mortality [hazard ratio, 95% confidence interval (95% CI)] for individuals with PeakSBP below the 10th percentile was 2.00 (1.59–2.52) in men and 2.60 (1.97–3.44) in women, compared with individuals within the 10th–90th percentile. The corresponding risk for incident cardiovascular disease was 1.55 (1.28–1.89, men) and 1.34 (1.05–1.71, women). For males in the upper 90th percentile, compared with individuals within the 10th–90th percentile, the adjusted risks of all-cause death and incident cardiovascular disease were 0.35 (0.22–0.54) and 0.72 (0.57–0.92), respectively, while not statistically significant in women. Spline modelling revealed a continuous increase in risk with PeakSBP values less than 100% of predicted in both sexes, with no increase in risk more than 100% of predicted. Conclusion: Low, but not high, PeakSBP was associated with an increased risk of mortality and future cardiovascular disease. Using reference standards for PeakSBP could facilitate clinical risk stratification across patients of varying sex, age and exercise capacity.</p>}},
  author       = {{Hedman, Kristofer and Lindow, Thomas and Cauwenberghs, Nicholas and Carlén, Anna and Elmberg, Viktor and Brudin, Lars and Ekström, Magnus}},
  issn         = {{0263-6352}},
  keywords     = {{Blood pressure; Epidemiology; Exercise testing}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{300--309}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Journal of Hypertension}},
  title        = {{Peak exercise SBP and future risk of cardiovascular disease and mortality}},
  url          = {{http://dx.doi.org/10.1097/HJH.0000000000003008}},
  doi          = {{10.1097/HJH.0000000000003008}},
  volume       = {{40}},
  year         = {{2022}},
}