Decreases in systolic blood pressure during exercise may predispose to arrhythmias
such as atrial fibrillation (AF) because of underlying abnormal autonomic tone. We
examined the association between systolic blood pressure response and incident AF
in 57,442 (mean age 54 ± 13 years, 47% women, and 29% black) patients free of baseline
AF who underwent exercise treadmill stress testing from the Henry Ford ExercIse Testing
project. Exercise systolic blood pressure response was examined as a categorical variable
across clinically relevant categories (>20 mm Hg: referent; 1 to 20 mm Hg, and ≤0 mm
Hg) and per 1-SD decrease. Cox regression, adjusting for demographics, cardiovascular
risk factors, medications, history of coronary heart disease, history of heart failure,
and metabolic equivalent of task achieved, was used to compute hazard ratios (HRs)
and 95% confidence intervals (CIs) for the association between systolic blood pressure
response and incident AF. Over a median follow-up of 5.0 years, a total of 3,381 cases
(5.9%) of AF were identified. An increased risk of AF was observed with decreasing
systolic blood pressure response (>20 mm Hg: HR 1.0, referent; 1 to 20 mm Hg: HR 1.09,
95% CI 0.99, 1.20; ≤0 mm Hg: HR 1.22, 95% CI 1.06 to 1.40). Similar results were obtained
per 1-SD decrease in systolic blood pressure response (HR 1.08, 95% CI 1.04 to 1.12).
The results were consistent when stratified by age, sex, race, hypertension, and coronary
heart disease. In conclusion, our results suggest that a decreased systolic blood
pressure response during exercise may identify subjects who are at risk for developing
AF.
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Article info
Publication history
Published online: October 02, 2015
Accepted:
September 22,
2015
Received in revised form:
September 22,
2015
Received:
August 3,
2015
Footnotes
Funding: Dr. Qureshi is funded by Ruth L. Kirschstein NRSA Institutional Training grant 5T32HL076132-10.
See page 1862 for disclosure information.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
