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Is Rest or Exercise Hypertension a Cause of a False-Positive Exercise Test?^*

^* From the Division of Cardiovascular Diseases and Department of Internal Medicine (Drs. Miller, Christian, Allison, Squires, and Gibbons), and the Department of Biostatistics and Health Sciences Research (Mr. Hodge), Mayo Clinic, Rochester, MN.

Correspondence to: Todd D. Miller, MD, FCCP, Mayo Clinic, East 16-A, 200 First Street SW, Rochester, MN 55905; e-mail: miller.todd{at}mayo.edu

Study objectives: To determine if a history of hypertension or an exaggerated rise in exercise systolic BP is associated with a false-positive exercise ECG.

Design, setting, and patients: Retrospective analysis of the associations between exercise-induced ST-segment depression and a history of hypertension, exercise systolic BP, and several other clinical and exercise test variables. Among 20,097 patients referred for exercise tomographic thallium imaging in a nuclear cardiology laboratory at a tertiary care center, 1,873 patients met inclusion criteria for this study, which included no history of myocardial infarction or coronary artery revascularization, a normal resting ECG, and normal exercise thallium images.

Results: False-positive ST-segment depression occurred in 20% of the population. A history of hypertension was actually associated with a lower likelihood of ST-segment depression (odds ratio, 0.70; 95% confidence interval [CI], 0.55 to 0.89; p = 0.004). A higher peak exercise systolic BP was associated with a higher likelihood of ST-segment depression (odds ratio, 1.08 for each 10-mm Hg increase in systolic BP; 95% CI, 1.03 to 1.14; p < 0.001). However, the association between peak exercise systolic BP and ST-segment depression was so weak that this measurement could not be predictive in the individual patient (R² = 0.2%). For every 20-mm Hg increase in peak exercise systolic BP, the percentage of patients with ST-segment depression increased by only 3%.

Conclusions: In patients with normal resting ECGs, we conclude the following: (1) a history of hypertension is not a cause of a false-positive exercise test, and (2) higher exercise systolic BP is a significant but weak predictor of ST-segment depression.

Key Words: BP • hypertension • ST-segment depression

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