Luan Perçuku1, Gani Bajraktari2, Haki Jashari3, Ibadete Bytyçi4, Pranvera Ibrahimi4, Michael Y Henein5. 1. Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo 2. Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden; University of Prishtina, Medical Faculty, Prishtina, Kosovo. gani.bajraktari@umu.se 3. Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden; Clinic of Pediatrics, University Clinical Centre of Kosova, Prishtina, Kosovo 4. Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden 5. Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden; Molecular and Clinical Sciences Research Institute, St George University London, United Kingdom; Brunel University, Middlesex, United Kingdom
Abstract
INTRODUCTION: The pathophysiology of exaggerated systolic hypertensive response to exercise (SHRE) is not fully understood, with contradictory data on its role in predicting cardiovascular (CV) events. OBJECTIVES: The aim of this review and meta‑analysis was to assess the association of SHRE with CV clinical outcomes in healthy normotensive individuals. PATIENTS AND METHODS: We searched PubMed (MEDLINE), Cochrane Library, RefWorks, and Google Scholar to identify clinical studies that reported data on CV event rates and outcomes for patients with SHRE on exercise stress testing. Sensitivity and specificity analysis for assessing the diagnostic accuracy of the SHRE cutoff associated with CV events was estimated using hierarchical summary receiver operating characteristic analysis. RESULTS: We included 8 studies with 47 188 participants and a median follow‑up of 19.3 years. Exaggerated SHRE was found in patients with composite events (CV mortality and coronary artery disease; hazard ratio [HR], 1.363; 95% CI, 1.135-1.604; P <0.001), in those with coronary artery events (HR, 1.532; 95% CI, 1.240-1.893; P <0.001), and in those with CV mortality (HR, 1.286; 95% CI, 1.075-1.539; P =0.006), as compared with individuals with normal response. An exercise systolic blood pressure of 196 mm Hg predicted CV events with a sensitivity of 62% (54%-69%) and specificity of 75% (60%-86%), with a positive likelihood ratio of less than 3 and a strong correlation (r = -0.71). CONCLUSIONS: Our study supports the clinical relevance of exaggerated SHRE as a predictor of composite and individual CV clinical outcome. These findings should be considered as thought‑provoking evidence for better stratification and, consequently, for optimal management of this high‑risk population.
INTRODUCTION: The pathophysiology of exaggerated systolic hypertensive response to exercise (SHRE) is not fully understood, with contradictory data on its role in predicting cardiovascular (CV) events. OBJECTIVES: The aim of this review and meta‑analysis was to assess the association of SHRE with CV clinical outcomes in healthy normotensive individuals. PATIENTS AND METHODS: We searched PubMed (MEDLINE), Cochrane Library, RefWorks, and Google Scholar to identify clinical studies that reported data on CV event rates and outcomes for patients with SHRE on exercise stress testing. Sensitivity and specificity analysis for assessing the diagnostic accuracy of the SHRE cutoff associated with CV events was estimated using hierarchical summary receiver operating characteristic analysis. RESULTS: We included 8 studies with 47 188 participants and a median follow‑up of 19.3 years. Exaggerated SHRE was found in patients with composite events (CV mortality and coronary artery disease; hazard ratio [HR], 1.363; 95% CI, 1.135-1.604; P <0.001), in those with coronary artery events (HR, 1.532; 95% CI, 1.240-1.893; P <0.001), and in those with CV mortality (HR, 1.286; 95% CI, 1.075-1.539; P =0.006), as compared with individuals with normal response. An exercise systolic blood pressure of 196 mm Hg predicted CV events with a sensitivity of 62% (54%-69%) and specificity of 75% (60%-86%), with a positive likelihood ratio of less than 3 and a strong correlation (r = -0.71). CONCLUSIONS: Our study supports the clinical relevance of exaggerated SHRE as a predictor of composite and individual CV clinical outcome. These findings should be considered as thought‑provoking evidence for better stratification and, consequently, for optimal management of this high‑risk population.
Authors: Pascal Bauer; Lutz Kraushaar; Sophie Hoelscher; Rebecca Weber; Ebru Akdogan; Stanislav Keranov; Oliver Dörr; Holger Nef; Christian W Hamm; Astrid Most Journal: Sports Med Int Open Date: 2021-04-19
Authors: Pascal Bauer; Lutz Kraushaar; Oliver Dörr; Holger Nef; Christian W Hamm; Astrid Most Journal: Eur J Appl Physiol Date: 2021-03-12 Impact factor: 3.346
Authors: Julio Alvarez-Pitti; Vesna Herceg-Čavrak; Małgorzata Wójcik; Dragan Radovanović; Michał Brzeziński; Carl Grabitz; Elke Wühl; Dorota Drożdż; Anette Melk Journal: Front Cardiovasc Med Date: 2022-09-30