Abstract 3110: Hypertensive Response with Exercise does not Increase the Prevalence of Abnormal Tc-99m SPECT Stress Perfusion Images
Objectives: The purpose of this study was to investigate whether an exaggerated elevation in systemic blood pressure (BP) with exercise is associated with an increased prevalence of abnormal SPECT stress myocardial perfusion images (MPI).
Background: Systemic hypertension and an exaggerated hypertensive response with exercise have been associated with ‘false-positive’ findings on stress electrocardiography and echocardiography; however, limited data is available for stress perfusion imaging.
Methods and Results: BP responses to exercise were assessed in a cohort of 7,208 patients who underwent exercise Tc-99m SPECT. A hypertensive response, defined as a peak systolic BP≥ 220 mmHg, occurred in 355 (4.9%) of patients and was not associated with an impaired functional aerobic capacity (89 ± 30 % versus 94 ± 26 %; p=0.07) or an increased prevalence of abnormal perfusion images (30.1% versus 32.9%; p=0.3). Patients with a hypertensive response and either intermediate or high-risk MPI (on the basis of summed difference scores) referred for coronary angiography, had a high prevalence of obstructive coronary artery disease which was similar to those without a hypertensive response (88% versus 83%; p=0.5). In an analysis of a subset of these patients, who had close follow-up as they received primary medical care at the Mayo Clinic and were residents of Rochester, Minnesota, a hypertensive response was not associated with a difference in either all-cause mortality or subsequent myocardial infarction, coronary revascularization or cardiac death (8% versus 9%; p=0.7).
Conclusion: A hypertensive blood pressure response to exercise is not associated with an increased rate of abnormal MPI or worse clinical outcome.