Prognostic significance of exercise versus resting blood pressure in patients with chronic heart failure

Background Results on the prognostic value of exercise blood pressure differ among studies; this may be related to the characteristics of the studied population. Objective To assess the prognostic significance of blood pressure measured during exercise in patients with chronic heart failure being considered for heart transplantation. Design and methods Symptom-limited bicycle exercise testing with measurement of blood pressure and respiratory gas analysis was performed in 274 potential candidates for heart transplantation. They were then followed up for mortality and cardiovascular events. Results Results are given as the mean ± SD. The age of the patients was 51.5 ± 11.0 years, the resting blood pressure was 114 ± 20/75 ± 12 mmHg, the peak work load was 91 ± 33 W and the peak oxygen uptake was 15.1 ± 5.0 ml/min per kg. The systolic blood pressure increased to 128 ± 21 mmHg at 30 W and to 133 ± 23 mmHg at 50% of the peak work load. During the total follow-up time of 513 years, 55 patients died and 145 suffered at least one cardiovascular event. After controlling for age, gender and body mass index, mortality and incidence of events were inversely related to the systolic pressure at 30 W or at 50% of the peak work load, or to both (P < 0.05). The inverse associations of outcome with the systolic pressure at 50% of the peak work load persisted after additional adjustment for resting pressure and for peak oxygen uptake. Conclusion The data indicate that a lower exercise systolic pressure, particularly at 50% of the peak work load, is associated with a higher mortality and a greater incidence of cardiovascular events.