Prognostic and predictive value of exertional hypotension in suspected coronary heart disease.

The prognostic and predictive value of exertional hypotension was assessed in 1,241 patients having treadmill maximal exercise testing, coronary arteriography, and follow-up averaging 5.4 years. Medically treated patients with coronary artery disease (CAD) with exertional hypotension had poorer survival than did those without such hypotension; however, maximum systolic pressure during exercise was a more powerful predictor of survival. Patients with exertional hypotension had more extensive CAD and more left ventricular (LV) dysfunction than did patients who had an increase in blood pressure with exertion; these findings probably account for the impaired survival. However, exertional hypotension, was an insensitive indicator of significant left main coronary artery stenosis, 3-vessel disease, or severe resting LV dysfunction.