Background: Although Dobutamine stress echocardiography (DSE) is clinically useful for the detection of coronary artery disease, false-negative and false-positive results have been reported in a significant number of studies. It has been reported that abnormal blood pressure response causes false-positive results in exercise stress test. We hypothesized that blood pressure response to dobutamine may influence the accuracy of DSE. Methods: Between February 2002 and May 2003, DSE was performed in 510 patients with suspected coronary artery disease. Of these patients, 68 patients (48 men, mean age: 62瑗�9 years) without resting wall motion abnormalities who underwent DSE and coronary angiography were studied. DSE was performed using a standard protocol. Significant coronary artery disease was defined as 50% stenosis. Results: Among 68 patients, DSE were accurate in 48 patients (Group 1). False-negative (Group 2) and false-positive (Group 3) results were present in 6 (9%) and 14 patients (20%), respectively. Group 2 showed lower peak systolic blood pressure (158瑗�32 vs 182瑗�30 mmHg, p=0.07) than Group 1. However, clinical and echocardiographic parameters including age, sex, left ventricular cavity size and wall thickness did not differ between the groups. Group 3 did not show any difference with Group 1. Conclusion: Patients with false-negative results for DSE tend to have lower peak systolic blood pressure than patients with accurate results. The accuracy of DSE appears to be influenced by blood pressure response to dobutamine.