The significance of abnormal systolic blood pressure response during supine ergometer exercise and postexercise in ischemic heart disease, studied by exercise radionuclide ventriculography.

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• The prognostic value of abnormal postexercise systolic blood pressure (BP) response has not been investigated. Therefore, the significance of abnormal BP response during exercise and postexercise was examined in 169 patients with ischemic heart disease subjected to supine ergometer exercise gated equilibrium radionuclide ventriculography, coronary arteriography, and follow up averaging 3.6 years.Abnormal BP response during exercise (exertional "hypotension") was defined as 1) a failure of BP to rise by at least 11mmHg or 2) an initial rise in BP but subsequent fall by more than 10mmHg during exercise. Abnormal BP response during postexercise (postexercise "hypertension") was defined as an increase of more than 10mmHg above the peak exercise BP.Of 169 patients, 51 (30%) had an abnormal BP response. Four types of BP response were identified: exertional "hypotension" (group 1a, n=11), postexercise "hypertension" (group 1b, n=30), exertional "hypotension" with postexercise "hypertension" (group 1c, n=10) and normal BP response (group 2, n=118). Both average exercise duration and peak heart rate were significantly lower in groups 1a, 1b and 1c than in group 2. The severity of exercise ST-segment depression was greater in groups 1b and 1c than in group 2. However, there was no significant difference in the severity of exercise ST-segment depression between group 1a and group 2. A decline in ejection fraction occurred more frequently in groups 1b and 1c than in group 2. Patients in groups 1a, 1b and 1c had more extensive coronary artery disease (CAD) than did patients in group 2. Medically treated patients with an abnormal BP response (groups 1a, 1b and 1c) had a poorer prognosis than did those with a normal BP response (group 2).These findings suggest that an abnormal BP response during supine exercise is infrequent, but is usually associated with impaired exercise tolerance and severe CAD. An abnormal postexercise BP response is also infrequent, but is more closely associated with evidence of myocardial ischemia and global left ventricular dysfunction than exertional "hypotension". In conclusion, postexercise "hypertension" has the same value as exertional "hypotension" as a predictor of poor prognosis.

• International Heart Journal刊行会の論文

著者

• Matsumoto Ryuma

  Cardiovascular Division, Department of Internal Medicine, Institute of Clinical Medicine, University

• Ogawa Takeshi

  Cardiovascular Division, Department of Internal Medicine, Institute of Clinical Medicine, University

• Iida Kaname

  Cardiovascular Division Department Of Internal Medicine Institute Of Clinical Medicine The Universit

• Watanabe Shigeyuki

  Cardiovascular Division Graduate School Of Comprehensive Human Sciences University Of Tsukuba

• Sugishita Yasuro

  Cardiovascular Division Department Of Internal Medicine And Department Of Gynecology And Obstetrics

• Ito Iwao

  Cardiovascular Division Department Of Internal Medicine And Department Of Gynecology And Obstetrics

• Fujita Takanori

  Cardiovascular Division Department Of Internal Medicine Institute Of Clinical Medicine The Universit

• Ajisaka Ryuichi

  Cardiovascular Division Department Of Internal Medicine Institute Of Clinical Medicine The Universit

• Masuoka Takeshi

  Cardiovascular Division Department Of Internal Medicine Institute Of Clinical Medicine

• AKISADA Masayoshi

  Cardiovascular Division, Department of Medicine, Institute of Clinical Medicine, University of Tsukuba

• IIDA Kaname

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

• WATANABE Shigeyuki

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

• TAKEDA Tohru

  Cardiovascular Division, Department of Internal Medicine, and Department of Radiology, Institute of Clinical Medicine, University of Tsukuba

• TOYAMA Hinako

  Cardiovascular Division, Department of Internal Medicine, and Department of Radiology, Institute of Clinical Medicine, University of Tsukuba

• ISHIKAWA Nobuyoshi

  Cardiovascular Division, Department of Internal Medicine, and Department of Radiology, Institute of Clinical Medicine, University of Tsukuba

• TAKEDA Tohru

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

• TOYAMA Hinako

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

• MASUOKA Takeshi

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

• FUJITA Takanori

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

• MATSUMOTO Ryuma

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

• ITO Iwao

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

• ISHIKAWA Nobuyoshi

  Cardiovascular Division, Departments of Internal Medicine and Radiology, Institute of Clinical Medicine, University of Tsukuba

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