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(Stroke. 2001;32:2036.)
© 2001 American Heart Association, Inc.

Original Contributions

Systolic Blood Pressure Response to Exercise Stress Test and Risk of Stroke

S. Kurl, MD; J. A. Laukkanen, MD; R. Rauramaa, MD, PhD, MSc; T. A. Lakka, MD, PhD; J. Sivenius, MD, PhD J. T. Salonen, MD, PhD, MScPH

From the Research Institute of Public Health (S.K., J.L., T.A.L., J.T.S.) and Department of Public Health and General Practice, University of Kuopio (J.T.S.); Research Institute of Exercise Medicine (J.L., T.A.L.), Kuopio; Department of Neurology (J.S.), University Hospital of Kuopio, Brain Research and Rehabilitation Centre Neuron, Kuopio; and Department of Clinical Physiology and Nuclear Medicine (R.R.), University Hospital of Kuopio and Research Institute of Exercise Medicine, Kuopio, Finland.

Reprint requests to Professor Jukka T. Salonen, Research Institute of Public Health, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland. E-mail Jukka.Salonen{at}uku.fi

Background and Purpose—— Systolic blood pressure (SBP) during exercise has been found to predict a future diagnosis of hypertension, coronary heart disease, and cardiovascular disease death. No studies have been conducted to show a relationship between SBP during exercise test and stroke. The aim of the present study was to study the associations between SBP rise, percent maximum SBP at 2 minutes after exercise, and the risk of stroke in a population-based sample of men with no prior coronary heart disease.

Methods—— SBP was measured every 2 minutes during and after the exercise test. The subjects were a population-based sample of 1026 men without clinical coronary heart disease, antihypertensive medication, or prior stroke at baseline. During an average follow-up of 10.4 years, there were 46 cases of stroke (38 ischemic strokes).

Results—— Men with SBP rise >19.7 mm Hg per minute of exercise duration had a 2.3-fold increased risk of any stroke and a 2.3-fold increased risk of ischemic stroke compared with men whose SBP rise was <16.1 mm Hg/min. Similarly, percent maximum SBP at 2 minutes after exercise (SBP at 2 minutes’ recovery divided by maximum SBP) was associated (highest tertile) with a 4.6-fold increased risk of any stroke and a 5.2-fold increased risk of ischemic stroke.

Conclusions—— SBP rise during exercise and percent maximum SBP at 2 minutes after exercise were directly and independently associated with the risk of all stroke and ischemic stroke. Exercise SBP testing may be recommended as an additional tool in the prediction of future stroke.

Key Words: blood pressure • exercise test • hypertension • risk factors • stroke prevention

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