Delayed blood pressure recovery after exercise stress test is associated with autonomic dysfunction and pulse pressure in a middle-aged healthy group

Abstract

Background: Delayed heart rate (HR) and blood pressure recovery after exercise test is known as the reliable indexes of autonomic dysfunction. Here we tried to evaluate the serial changes in various indicators during exercise test and correlations with recovery of HR and blood pressure in a normotensive healthy middle-aged group.

Methods: A total of 122 patients without hypertension or diabetes was enrolled (mean age, 55.6 ± 11.0; male, 56.6%; mean blood pressure, 124.8 ± 16.6 / 81.5 ± 9.6 mmHg). Treadmill test was performed for evaluation of chest pain. Patients with coronary artery disease, positive treadmill test result, left ventricular dysfunction or renal failure were excluded. Heart rate recovery was calculated by subtracting the HR in the first or second minute of recovery period from the HR of peak exercise (HRR1 or HRR2). Systolic blood pressure in the 4th minute of recovery stage (SBPR4) was used to show delayed blood pressure recovery.

Results: Metabolic equivalents (METs) and HR in stage 2 to 4 were significantly correlated with both HRR1 and HRR2. Multiple regression analysis of HRR revealed significant correlation of METs and SBPR4. SBPR4 was significantly correlated with both HRR1 and HRR2 (HRR1, r = -0.376, p<0.001; HRR2, r = -0.244, p = 0.008) as well as SBP in the baseline to stage 3 and pulse pressure (r = 0.406, p<0.001).

Conclusions: Delayed BP recovery after peak exercise test revealed significant association with autonomic dysfunction and increased pulse pressure in normotensive middle-aged healthy group. It can be a simple and useful marker of autonomic dysfunction and arterial stiffness.

Fig 1. Correlation of HRR in the first minute of recovery stage with other basic and hemodynamic parameters.

Abbreviations. HRR1min, HRR in the first minute of recovery stage, METs, metabolic equivalents; recovery4min SBP, systolic blood pressure in the 4^th minute of recovery stage; HR, heart rate. *p < 0.05.

Fig 2. Correlation of SBP in the 4^th minute of recovery stage with other basic and hemodynamic parameters.

Abbreviations. SBPrecovery4min, systolic blood pressure in the 4^th minute of recovery stage; DBPrecovery4min, diastolic blood pressure in the 4^th minute of recovery stage; HRR1,2min, HRR in the first and second minute of recovery stage. *p < 0.05.