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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Exercise-induced hypotension in a male population. Criteria, causes, and prognosis.Circulation. 1988; 78: 1380-1387
- Prediction of cardiovascular death by means of clinical and exercise test variables in patients selected for cardiac catheterization.Am Heart J. 1993; 125: 1717-1726
- Prognostic value of hypotensive blood pressure response during single-stage exercise test on long-term outcome in patients with known or suspected peripheral arterial disease.Coron Artery Dis. 2008; 19: 603-607
- Low exercise blood pressure and risk of cardiovascular events and all-cause mortality: systematic review and meta-analysis.Atherosclerosis. 2014; 237: 13-22
- Systolic blood pressure response during exercise stress testing: the Henry Ford ExercIse testing (FIT) project.J Am Heart Assoc. 2015; 4
- Anatomic and functional significance of a hypotensive response during supine exercise radionuclide ventriculography.Am J Cardiol. 1987; 60: 1-4
- Impaired left ventricular function during exercise in coronary artery disease and exertional hypotension.Cardiology. 1988; 75: 24-31
- Mechanism of exercise hypotension in patients with ischemic heart disease. Role of neurocardiogenically mediated vasodilation.Circulation. 1994; 90: 2701-2709
- Fluctuation in autonomic tone is a major determinant of sustained atrial arrhythmias in patients with focal ectopy originating from the pulmonary veins.J Cardiovasc Electrophysiol. 2001; 12: 285-291
- Autonomic tone variations before the onset of paroxysmal atrial fibrillation.Circulation. 2002; 105: 2753-2759
- Rationale and design of the Henry Ford Exercise Testing project (the FIT project).Clin Cardiol. 2014; 37: 456-461
- Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease.Am Heart J. 1973; 85: 546-562
- Quantile regression and restricted cubic splines are useful for exploring relationships between continuous variables.J Clin Epidemiol. 2009; 62: 511-517
- Exercise standards for testing and training: a scientific statement from the American Heart Association.Circulation. 2013; 128: 873-934
- Prognostic significance of systolic blood pressure increases in men during exercise stress testing.Am J Cardiol. 2007; 100: 1609-1613
- Clinical and exercise test predictors of all-cause mortality: results from >6,000 consecutive referred male patients.Chest. 2001; 120: 1003-1013
- Diagnostic exercise tests on 4000 consecutive men.Am Heart J. 2001; 142: 127-135
- Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study.JAMA. 1994; 271: 840-844
- The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-up study.Am J Med. 1995; 98: 476-484
- Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study.Circulation. 2008; 118: 800-807
- Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford Exercise Testing (FIT) project.Circulation. 2015; 131: 1827-1834
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.