PREDICTORS AND PROGNOSTIC VALUE OF HYPERTENSIVE BLOOD PRESSURE RESPONSE DURING STRESS ECHOCARDIOGRAPHY IN PATIENTS WITH HYPERTENSION.

Objective: To evaluate the frequency, predictors and prognostic value of hypertensive response to exercise (HRE) during stress echocardiography (SE) in patients with hypertension and known or suspected coronary artery disease (CAD).Design and method: Blood pressure (BP) response to exercise during SE was analyzed in 378 patients with known or suspected CAD (age 63 (56; 68) years, 217 men, 57.4%, history of myocardial infarction 94 (24.9%), diabetes mellitus type 2 108 (28.5%)) in a single-center prospective study. BP response was considered hypertensive if systolic BP (SBP) >190 mmHg. on a treadmill and 200 mmHg on a bicycle ergometer in women and >210 mmHg and 220 mmHg, respectively, in men, or with an increase in SBP relative to the baseline in men >60 mmHg, in women >50 mmHg. The frequency of HRE, predictors of its occurrence and the relationship with the probability of detecting significant CAD were studied. Results: HRE was observed in 162 patients (42.9%). Predictors of HRE development according to multivariate analysis with inclusion of significant clinical and echocardiographic correlations: chest pain characteristics (OR 0.77, 95% CI (0.61; 0.97), p=0.025) and left ventricular contractile reserve (OR 3.5, 95% CI (2.1; 5.9), p<0.001). During the observation period (205 (38; 371) days), 19 (11.7%) patients from the HRE group and 42 (27.1%) patients from the normotonic reaction of BP group underwent revascularization. Survival of patients without detection of significant coronary artery lesions is better in patients with HRE (p=0.007). Conclusions: In patients with hypertension the probability of developing HRE is affected by the contractile reserve and the chest pain characteristics. The HRE during SE independently influences the probability of detecting significant coronary lesions.