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Adjudication committee
- First opponent: Chief Physician Tine Willum Hansen, Steno Diabetes Center
- Second opponent: Professor Reinhold Kreutz, Charité Universitätsmedizin
- Third member and chair of the evaluation committee: Professor II Thor Edvardsen, University of Oslo
Chair of the Defence
Professor II Dag Jacobsen, University of Oslo
Principal Supervisor
Per Torger Skretteberg, Oslo University Hospital
Summary
There are conflicting results regarding exercise blood pressure as a predictor for later cardiovascular disease, but increasing evidence supports the finding of exercise systolic blood pressure as a predictor for later cardiovascular disease in healthy people. In this thesis the aim was to further investigate exercise systolic blood pressure as a predictor for cardiovascular disease in general, and coronary disease and cerebral stroke specifically.
Two-thousand-and-fourteen healthy Norwegian men aged 40-59 years from the cohort study Oslo Ischemia Study underwent thorough clinical examination during the early 1970s. The participants performed an ergometer bicycle exercise test starting at 100 W workload and continued until near exhaustion, with six-minute intervals and 50 W increase in workload at each interval. Systolic blood pressure was measured at rest and every two minutes during the exercise test. In multivariate analyses, exercise systolic blood pressure at 100 W workload predicted cardiovascular disease during 35 years of follow-up. When only investigating participants remaining healthy during an initial seven-year follow-up period, exercise systolic blood pressure showed a linear relationship to coronary disease, also independent of systolic blood pressure at rest, indicating no distinct threshold level for increased risk of coronary disease. When investigating increase in systolic blood pressure from rest until maximal exercise as a predictor for cerebral stroke, the risk curve appears to be J-shaped.
In conclusion, there seems to be a linear association between exercise systolic blood pressure and coronary disease already from low blood pressure levels, independent of resting blood pressure. There also seems to be a trend towards exercise blood pressure measured at moderate workload predicting coronary disease, whereas an exaggerated increase in maximal exercise systolic blood pressure from resting conditions is an independent predictor for cerebral stroke.
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