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European Heart Journal 1991 12(11):1195-1197;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Exercise induced increase in diastolic blood pressure. Is it an indicator of coronary artery disease?

D. ACANFORA*, L. DE CAPRIO{dagger}, A. DI PALMA{dagger}, S. PARLATI{dagger}, C. LIRATO{dagger}, D. F. VITALE, M. ROSSI* and F. RENGO*,{dagger}

*Fondazione Clinica del Lavoro, Centro Medico di Campoli Monte Taburno, Istituto di Ricovero e Cura a Carattere Scient Benevento
{dagger}Cattedra di Geriatria, II Facoltà di Medicina e Chirurgia Federico II, Napoli, Italy

Received 16 January 1990; revised 29 November 1990; .

Correspondence: Dottor Domenico Acanfora, Via Ponte Izzo No. 22, 80045 Pompei (Napoli), Italy

Abstract

It has been previously reported that an increase in diastolic blood pressure greater than 15 mmHg comparing values at rest with those on treadmill exercise, with or without ST changes, enhances the probability of coronary artery disease. To investigate whether the diastolic blood pressure variation keeps its diagnostic value during upright bicycle exercise, we evaluated the diastolic blood pressure variations in 111 patients with angiographically documented coronary artery disease without previous myocardial infarction and in 53 patients with normal coronary arteries undergoing maximal stress testing on a bicycle ergometer. The sensitivity of diastolic blood pressure (DBP) variations to detect coronary artery disease was 66%, the specificity 32%, the positive predictive value 67%, the negative predictive value 31% and the predictive accuracy 55%. The respective values for ST depression were 83% (P<0·001 vs DBP variations), 53% (P<0· vs DBP variations), 64% (P<0·05 vs DBP variations) and 75% (P<0·001 vs DBP variations).

Forty-nine of the 75 patients with multivessel coronary artery disease and 60 of the 89 patients without coronary artery disease or with single vessel disease had abnormal DBP variations (sensitivity 65; spec 33%). The sensitivity of ST segment depression in predicting multivessel disease was 91% (P<0·001 vs DBP variations), and the specficity 42%.

Thus for bicycle ergometer exercise testing, ST segment depression seems to be more accurate than DBP variations in the diagnosis of coronary artery disease.

Key Words: Coronary artery disease • exercise test • diastolic blood pressure


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