***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The objective of this study was to demonstrate the causes , optimal definition , and predictive value of exercise-induced hypotension occurring during treadmill testing . This study included all patients referred for clinical reasons to the Long Beach Veterans Administration Medical Center treadmill laboratory and then followed for a 2-year period for cardiac events . The population consisted of 2,036 patients who underwent testing from April 4 , 1984 , to May 7 , 1987 , 131 of whom exhibited exercise-induced hypotension ( 6.4 % ) . We found that exercise-induced hypotension is usually related to myocardial ischemia or myocardial infa rct ion , is best defined as a drop in systolic blood pressure during exercise below the st and ing preexercise value , and indicates a significantly increased risk for cardiac events ( 3.2-fold , p less than 0.005 ) . This increased risk was not found in those having no previous myocardial infa rct ion or no signs or symptoms of ischemia during the exercise test , and the increased risk was also not found in those undergoing a treadmill test within 3 weeks after a myocardial infa rct ion . Exercise-induced hypotension appeared to be reversed by revascularization procedures , but confirmation of a beneficial effect on survival requires a r and omized trial . The clinical importance of this study is that we have demonstrated that a drop in systolic blood pressure below st and ing preexercise values during treadmill testing indicates an increased risk for cardiac events except in certain subsets of patients OBJECTIVES This study was design ed to assess the angiographic and prognostic implication s of an exaggerated systolic blood pressure response to exercise ( " exercise hypertension " ) in adults undergoing evaluation for suspected coronary artery disease . BACKGROUND The clinical implication s of exercise hypertension are unclear . METHODS Subjects for this prospect i ve cohort study were derived from a consecutive sample of 9,608 adults who were referred for treadmill testing and who augmented their systolic blood pressure by at least 10 mm Hg . There were 594 subjects who underwent coronary angiography within 90 days of treadmill testing . Exercise hypertension  was defined as a peak exercise systolic blood pressure > or = 210 mm Hg in men and > or = 190 mm Hg in women . Severe angiographic coronary disease was defined as left main coronary artery disease ( > or = 50 % diameter stenosis ) , three-vessel disease ( > or = 70 % diameter stenosis ) or two-vessel disease with > or = 70 % diameter stenosis of the proximal left anterior descending coronary artery . All-cause mortality was assessed during a follow-up period of approximately 2 years . RESULTS  Exercise hypertension  was present in 196 subjects ( 33 % ) . Severe coronary disease was less common in subjects with  exercise hypertension  ( 14 % vs. 25 % , odds ratio 0.51 , 95 % confidence interval [ CI ] 0.32 to 0.81 , p = 0.004 ) . Exercise hypertension remained associated with a lower rate of severe coronary disease even after adjusting for rest hypertension , age , gender , exercise capacity and other possible confounders . During the follow-up period , there were 23 deaths ; only 2 occurred in the group with exercise hypertension . After adjusting for severity of coronary disease , exercise hypertension remained associated with a lower mortality rate ( adjusted relative risk 0.20 , 95 % CI 0.05 to 0.84 , p = 0.03 ) . CONCLUSIONS In adults evaluated for coronary artery disease , exercise hypertension is associated with a lower likelihood of angiographically severe disease and a lower adjusted mortality rate Background —Predicting the risk of cardiac and all-cause death in patients with established coronary heart disease is important in counseling the individual and design ing risk-stratified rehabilitation and secondary prevention programs . Cox proportional hazards and Kaplan-Meier survival curves were thus completed on initial assessment data obtained from patients referred to an outpatient cardiac rehabilitation center . Methods and Results —A single-center prospect i ve observational design took peak cardiorespiratory exercise test data for 12 169 male rehabilitation c and i date s aged 55.0±9.6 years ( 7096 myocardial infa rct ions [ MIs ] , 3077 coronary artery bypass grafts [ CABGs ] , and 1996 documented cases of ischemic heart disease [ IHD ] ) . A follow-up of 4 to 29 years ( median , 7.9 ) yielded 107 698 man-years of experience . Entry data were tested for associations with time to cardiac and all-cause death . We recorded 1336 cardiac deaths ( 953 MI , 225 CABG , and 158 IHD ) and 2352 all-cause deaths . A powerful predictor of cardiac and all-cause mortality was measured peak oxygen intake ( & OV0312;o2peak ) . For the overall sample , values of < 15 , 15 to 22 , and > 22 mL/kg per minute yielded respective multivariate adjusted hazard ratios of 1.00 , 0.62 , and 0.39 for cardiac and 1.00 , 0.66 , and 0.45 for all-cause deaths . For the separate diagnostic categories , apart from & OV0312;o2peak , the only other significant predictors of cardiac death common to all 3 were smoking and digoxin , and for all-cause death , age , smoking , digoxin , and diabetes . Conclusions —Exercise capacity , as determined by direct measurement of & OV0312;o2peak , exerts a major long-term influence on prognosis in men after MI , CABG , or IHD and can play a valuable role in risk stratification and counseling Exercise testing helped in diagnosing postinfa rct ion patients in the prethrombolytic era . Over the past decade acute myocardial infa rct ion treatment has changed because of new thrombolytic therapies and consequently , the value of exercise testing is under debate . The GISSI-2 data base allowed us to reevaluate the prognostic role of exercise testing in thrombolysed patients . The exercise test was performed in 6296 patients , on average 28 days after r and omisation . The test was not performed in 3923 patients because of contraindications . The test was judged positive for residual ischaemia in 26 % of the patients , negative in 38 % , and non-diagnostic in 36 % . Among the patients with a positive stress test result , 33 % had symptoms , whereas 67 % had silent myocardial ischaemia . The mortality rate was 7.1 % among patients who did not have an exercise test and 1.7 % [ correction of 7.1 % ] for those with a positive test , 0.9 % for those who had a negative test , and 1.3 % for those who did not have a diagnostic test . In the adjusted analysis , symptomatic induced ischaemia , submaximal positive result , low work capacity , and abnormal systolic blood pressure were independent predictors of 6-month mortality ( relative risks [ RR ] 2.54 , 95 % CI 1.27 - 5.08 , 2.28 , 1.17 - 4.45 , 2.05 , 1.23 - 3.42 , and 1.86 , 1.05 - 3.31 , respectively ) . However , when these factors were tested simultaneously , only symptomatic induced ischaemia and low work capacity were confirmed as independent predictors of mortality ( RR Cox 2.07 , 95 % CI 1.02 - 4.23 and 1.78 , 1.06 - 2.99 , respectively ) . Patients with a normal exercise response have an excellent medium-term prognosis and do not need further investigation . However , more evaluation should be devoted to the patients who can not undergo exercise testing  , because the potential to influence outcome appears to be much greater OBJECTIVES The present study was design ed to prospect ively evaluate the prognostic relevance of abnormal blood pressure response to  exercise  ( ABPR ) , defined as hypotension or failed blood pressure increase ( < 20 mm Hg ) with exercise , in a community-based hypertrophic cardiomyopathy ( HCM ) population representative of the overall disease spectrum . BACKGROUND Abnormal blood pressure response to exercise has been proposed as a marker for hemodynamic instability and increased risk for disease-related mortality in highly selected patient population s with HCM . METHODS The study population comprised 126 patients ( aged 42+/-14 years ) who underwent maximal symptom-limited cycloergometer exercise testing as part of the st and ard evaluation at our institution , and who were followed systematic ally for 4.7+/-3.7 years after testing . RESULTS Of the 126 study patients , 98 ( 78 % ) had a normal blood pressure response during exercise , whereas the other 28 ( 22 % ) had ABPR , including nine with hypotension and 19 with failed blood pressure rise . During the follow-up period , nine patients ( 7 % ) died of HCM-related causes ( three suddenly and six heart failure-related ) , of whom four had ABPR . In those patients aged < or = 50 years , survival analysis after exercise testing showed a significantly increased risk for cardiovascular mortality associated with ABPR compared with a normal exercise response ( p = 0.04 ) , with an odds ratio of 4.5 ( 95 % confidence interval : 1.1 , 20.1 ) . However , ABPR showed low positive predictive accuracy for cardiovascular mortality ( i.e. , 14 % ) , whereas negative predictive accuracy was high ( i.e. , 95 % ) . CONCLUSIONS A hypotensive blood pressure response during exercise occurred in over 20 % of a community-based patient cohort with HCM , and was associated with adverse long-term prognosis in patients < 50 years old . However , the positive predictive accuracy of this blood pressure response is too low to justify modifications of clinical management or to allow identification of the high-risk patient based solely on an abnormal test result . By virtue of its high negative predictive accuracy for HCM-related mortality , the blood pressure response to exercise appears to be most valuable ( in conjunction with the absence of other well recognized risk factors ) as a screening test for the identification of low-risk subsets of patients Objective : Studies on the prognostic importance of the systolic blood pressure ( SBP ) response during exercise report ambiguous results . Most research focuses on younger and middle-aged selected patient groups and rarely includes women . We investigated the prognostic value of SBP response during exercise testing in 75-year-olds . Design : Prospect i ve observational cohort study . Setting : A community-based r and om sample of 75-year-old men and women ( n = 382 ) . Main outcome measures : The prognostic value of SBP change  from rest to peak exercise during a symptom-limited cycle test was evaluated for the endpoints all-cause mortality and cardiovascular mortality during long-term follow-up . Results : After a median follow-up of 10.6 years , 140 ( 37 % ) of the participants had died , 64 ( 17 % ) from cardiovascular causes . The all-cause mortalities for exercise SBP changes of ⩽30 mm Hg , 31–55 mm Hg and > 55 mm Hg were 5.1 , 4.2 and 2.6 per 100 person-years , respectively ( logrank 9.6 ; p = 0.008 ) . For every 10 mm Hg increase in SBP during exercise the relative hazard for all-cause mortality was reduced by 13 % ( p = 0.030 ) and for cardiovascular mortality by 26 % ( p = 0.004 ) after adjustment for sex , smoking , waist circumference , total/HDL cholesterol ratio , prevalent ischaemic heart disease , hypertension , diabetes , cardiovascular medication , pre-exercise SBP , exercise capacity , resting left ventricular ejection fraction and left ventricular mass index . Conclusions : Our findings suggest that an augmented SBP response  during exercise is associated with an improved long-term survival among community-living 75-year-old individuals The relation of maximal exercise systolic pressure to physical conditioning and to mortality was determined in 641 men with > or = 1 myocardial infa rct ions . Each performed a st and ardized multistage exercise test before r and omized assignment either to an exercise group or a control group and at scheduled periodic intervals over 3 years . This study compares 123 men with maximal exercise systolic pressures ( MESP ) of < or = 140 mm Hg with 518 men whose maximal exercise systolic pressure was > or = 140 mm Hg . At baseline , the 2 groups were comparable for age , entry time since the occurrence of the qualifying cardiac event , and reported use of antihypertensive medications . Men with low MESP used more  beta blockers  , had lower systolic pressure measurements at rest and by definition at maximal exercise , and lower work capacity than men with higher levels of MESP . Men with low MESP experienced : ( 1 ) no reduction in mortality with exercise conditioning  ( p<0.86 ) , and ( 2 ) a significantly higher mortality rate over 3 years ( p<0.003 ) compared with men with higher levels of MESP . The relation of a low MESP to mortality persisted : ( 1 ) whether MESP or work capacity increased from the baseline exercise test to the last performed exercise test , and ( 2 ) whether it 
    Output:
    
Our data show that irrespective of clinical or exercise conditions , LowExBP independently predicts fatal and non-fatal cardiovascular events and all-cause mortality