Work

Association of exercise blood pressure relative to fitness with coronary artery disease

Year: 2026

Type: article

Abstract: Background Exercise systolic blood pressure (SBP) indexed to fitness, expressed as SBP divided by peak metabolic equivalents (SBP/MET peak), is associated with cardiovascular events in patients undergoing exercise testing. We aimed to characterise the cardiac phenotype and outcomes of patients with elevated exercise SBP indexed to fitness.Methods We analysed 530 participants with suspected angina from the CE-MARC trial who had complete exercise treadmill testing, invasive coronary angiography (ICA) and cardiovascular magnetic resonance (CMR) imaging. High SBP/MET peak was defined as ≥18 mm Hg/METs. Obstructive coronary artery disease (CAD) was defined by quantitative ICA as ≥70% stenosis in a major epicardial artery. Inducible ischaemia and myocardial scar were assessed by stress perfusion and late gadolinium enhancement CMR, respectively. Major adverse cardiovascular events (MACE) were defined as all-cause death and acute coronary syndrome.Results High SBP/MET peak was present in 310 participants (58.5%) and prevalence increased progressively with the number of diseased vessels, presence of ischaemia and myocardial scar (p<0.01 for all). During a median follow-up of 15.9 years, high SBP/METpeak was associated with MACE after adjustment for age, sex, obstructive CAD, ischaemia and myocardial scar (adjusted HR per 1-unit increase, 1.02 (95% CI 1.00 to 1.03), p=0.012). Higher SBP/METpeak identified a worse prognosis in subgroups with and without obstructive CAD and in those with and without ischaemia or infarction (log-rank, p<0.005 for all).Conclusions Among patients with suspected angina, high SBP/MET peak was associated with myocardial ischaemia and scar and adverse long-term outcomes. However, this association appeared to be driven predominantly by lower exercise capacity rather than peak SBP. SBP/METpeak may therefore represent an exploratory integrated exercise marker requiring external validation.

Source: Open Heart

DOI: 10.1136/openhrt-2026-004514