Exercise Blood Pressure Response, Albuminuria, and Arterial Stiffness in Patients with Hypertension
Article Outline
To the Editor:
We read with great interest the article by Tsioufis et al1 reporting on the relationship of exercise blood pressure response with albuminuria and arterial stiffness in patients with hypertension. We commend the authors on their insightful study. However, there are a number of points that deserve comment.
The authors state in the introduction that exercise blood pressure response is associated with a higher risk of cardiovascular mortality. However, they should acknowledge that such a statement is controversial at best. Lauer et al2 found that an exaggerated exercise blood pressure response was associated with a lower likelihood of significant coronary artery disease and a lower adjusted mortality rate. Gupta et al3 reported that an increase in systolic blood pressure of 44 mm Hg or more during exercise was independently associated with improved survival, even in patients with a history of hypertension. In addition, Kane et al4 failed to find a significant association between a hypertensive response to exercise and myocardial ischemia, all-cause mortality or subsequent cardiac events.
On the other hand, the reproducibility of an exaggerated exercise blood pressure response has been reported to be low. In the study by Sharabi et al,5 only 15.4% of the patients with exercise blood pressure response exhibited this response in at least two thirds of the stress tests performed, and no clinical characteristics identifying those with consistent responses could be ascertained. Therefore, the clinical value of the association of exercise blood pressure response with urinary albumin excretion and arterial stiffness may be questionable.
References
- Exercise blood pressure response, albuminuria, and arterial stiffness in hypertension. Am J Med. 2008;12:894–902
- Angiographic and prognostic implications of an exaggerated exercise systolic blood pressure response and rest systolic blood pressure in adults undergoing evaluation for suspected coronary artery disease. J Am Coll Cardiol. 1995;26:1630–1636
- Prognostic significance of systolic blood pressure increases in men during exercise stress testing. Am J Cardiol. 2007;100:1609–1613
- Hypertensive response with exercise does not increase the prevalence of abnormal Tc-99m SPECT stress perfusion images. Am Heart J. 2008;155:930–937
- Reproducibility of exaggerated blood pressure response to exercise in healthy patients. Am Heart J. 2001;141:1014–1017
PII: S0002-9343(08)01061-9
doi:10.1016/j.amjmed.2008.10.020
© 2009 Elsevier Inc. All rights reserved.
