Hypertensive response with exercise does not increase the prevalence of abnormal Tc-99m SPECT Stress Perfusion Images

• Published in: The American heart journal 2008-05, Vol.155 (5), p.930-937
• Main Authors: Kane, Garvan C., MD, PhD, Askew, John W., MD, Chareonthaitawee, Panithaya, MD, Miller, Todd D., MD, Gibbons, Raymond J., MD
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Coronary Artery Disease - diagnosis; Coronary vessels; Diabetes; Echocardiography, Stress; Electrocardiography; Exercise; Exercise Test; Family medical history; Female; Fitness equipment; Heart attacks; Heart rate; Humans; Hypertension; Hypertension - physiopathology; Male; Medical imaging; Medical records; Medical sciences; Middle Aged; Mortality; Pain; Prevalence; Retrospective Studies; Studies; Tomography, Emission-Computed, Single-Photon; Variables; Variance analysis
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2007.12.017

Background Systemic hypertension and an exaggerated blood pressure (BP) response with exercise have been associated with ‘false-positive’ findings on stress electrocardiography and echocardiography; however, limited data is available for stress myocardial perfusion imaging (MPI). The purpose of this study was to investigate whether an exaggerated elevation in BP with exercise is associated with an increased prevalence of abnormal MPI. Methods BP responses to exercise were assessed in a cohort of 7,205 patients who underwent stress testing with technetium 99m-SPECT MPI (7/1999-6/2005) for the evaluation of chest pain or dyspnea. Results A hypertensive response, defined as a peak systolic BP≥220 mmHg, occurred in 355 (4.9%) and was not associated with higher rates of ischemic ECG changes (16.1 versus 16.6%; P = .7), differences in Duke treadmill scores (4.7 ± 4 versus 5.1 ± 5; P = .3) or an increased prevalence of abnormal perfusion images (30.1% versus 32.9%; P = .3) to those without a hypertensive exercise response. Patients with a hypertensive response and either intermediate or high-risk MPI (on the basis of summed-difference-scores) referred for coronary angiography, had a high prevalence of coronary artery disease which was similar to those without a hypertensive response (88% versus 83%; P = .5). In an analysis of a community-based patient subset, a hypertensive response was not associated with a difference in either all-cause mortality or subsequent myocardial infarction, coronary revascularization or cardiac death (8% versus 9%; P = .7). Conclusion A hypertensive BP response to exercise is not associated with increased rates of ischemic ECG changes, higher-risk Duke treadmill scores, greater degrees of abnormal MPI or worse clinical outcome.