AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Post-Exercise Recovery Blood Pressure and the Risk of Acute Ischemic Stroke
By Guo CY, Huang WM, Sung SH
Background: Stroke remains a major cause of long-term disability and mortality. While resting blood pressure (BP) is an established cerebrovascular risk factor, post-exercise hemodynamics may provide superior insights into an individual's underlying neurohormonal, autonomic, and vascular profile. Study Question Can BP measured during the recovery phase of a treadmill stress test predict future acute ischemic stroke events? Methods We conducted a retrospective cohort study of patients who underwent treadmill stress testing between 2003 and 2012 at a medical center. BP measurements were recorded at rest, peak exercise, and during the post-exercise recovery phase. Multivariable Cox proportional hazards regression analysis was performed to evaluate the association of recovery systolic BP (SBP) and diastolic BP (DBP) with new acute ischemic stroke. Models were adjusted for age, sex, metabolic profile, medical comorbidities, and medications. Additionally, Kaplan-Meier survival analysis with the log-rank test was performed to evaluate stroke-free survival probabilities stratified by recovery DBP tertiles. Results: A total of 15,268 patients were included in the final analysis (mean age 60.3±9.6 years; 59% male; 42% with pre-existing hypertension). Over a median follow-up period of 8.8 years, 1,712 patients (11.21%) experienced acute ischemic stroke and 1,586 patients (10.39%) expired. After multivariable adjustment, elevated recovery SBP (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 1.03-1.17 per standard deviation [29.20 mmHg]) and recovery DBP (HR: 1.12; 95% CI: 1.05-1.19 per standard deviation [13.79 mmHg]) were both associated with an increased risk of stroke. Kaplan-Meier survival curves demonstrated a significant, stepwise inverse relationship between recovery DBP tertiles and stroke-free survival. Patients in the highest recovery DBP tertile exhibited the lowest stroke-free survival probability, whereas those in the lowest tertile maintained the highest (log-rank p<0.001). Conclusion: Elevated post-exercise recovery BP is an independent predictor of acute ischemic stroke. Higher recovery DBP was associated with lower stroke free survival probability. These findings suggest that post-exercise recovery hemodynamics can enhance risk stratification models and may be integrated into stress test interpretations for prevention of stroke.