Exaggerated exercise blood pressure response and risk of stroke in patients referred for stress testing

•Resting hypertension is a major predictor of stroke.•We failed to find an association between exercise blood pressure and stroke.•These results were consistent regardless of the type of stroke.

Background/objectivesThere is some evidence to suggest that exercise systolic blood pressure (SBP) may be associated with future risk of stroke in subjects without a history of coronary artery disease (CAD). However, the value of an exaggerated exercise SBP response (EESBPR) for predicting stroke in patients referred for stress testing for clinical reasons has not been investigated.MethodsWe evaluated a community-based sample of 10,047 patients with known or suspected CAD who underwent treadmill exercise echocardiography. An EESBPR was defined as a peak exercise SBP of > 220 mmHg. The ratio of the increase in SBP during exercise to exercise workload (ΔSBPeEW) was also estimated. The endpoints were stroke of any type, ischemic stroke and hemorrhagic stroke. Median follow-up was 3.5 years.ResultsAnnualized rates of stroke of any type, ischemic stroke and hemorrhagic stroke were 0.6% (95% CI 0.53–0.67), 0.49% (95% CI 0.42–0.56) and 0.12% (95% CI 0.09–0.15) in patients without EESBPR vs. 0.69% (95% CI 0.37–1), 0.49% (95% CI 0.23–0.76) and 0.19% (95% CI 0.02–0.35) in those with EESBPR (p = 0.68, 0.90 and 0.39, respectively). Similarly, there was no significant univariate association between ΔSBPeEW and the occurrence of any endpoint. In multivariate analysis, hypertension, male sex, age, diabetes mellitus and resting SBP remained predictors of stroke of any type. EESBPR and ΔSBPeEW were not predictors of any of the endpoints evaluated.ConclusionWe did not observe any significant association between exercise SBP and the future occurrence of stroke in patients with known or suspected CAD referred for exercise echocardiography.