Hypertensive Response to Exercise: A Potential Cause for New Wall Motion Abnormality in the Absence of Coronary Artery Disease

OBJECTIVES We sought to characterize patients with a hypertensive response during exercise echocardi-ography and its effect on results of the test. BACKGROUND A hypertensive response to exercise has been shown to cause false-positive results in perfusion imaging, radionuclide angiography and exercise electrocardiography, but its influence on exercise echocardiography has not been reported. METHODS We identified 548 of 6,686 patients who had coronary angiography within four weeks after exercise echocardiography from 1992 through 1996. Echocardiographic results from 132 patients (24%) with a hypertensive response to exercise, defined as systolic blood pressure (SBP)220 mm Hg for men and SBP190 mm Hg for women or as an increase in diastolic blood pressure (DBP) 10 mm Hg or DBP 90 mm Hg during exercise echocardiography, were compared with those from 416 patients without a hypertensive response. RESULTS Of 132 patients with a hypertensive response to exercise, 108 patients had exercise echocardiographic results positive for ischemia. Of these patients, 24 (22%) were found to have no significant coronary artery disease (CAD). In contrast, of 320 patients with positive exercise echocardiographic results without a hypertensive response, 39 (12%) patients did no