BACKGROUND: The purpose of the present study was to assess the safety and hemodynamic response of high dose dobutamine echocardiography (DE) in different age groups. DE is frequently used in the diagnosis of coronary artery disease; its safety in very elderly patients is not established, and there are no standards for blood pressure and heart rate response. METHODS AND RESULTS: The test was performed using up to 50 µg/kg/min in 400 patients: 164 middle-aged (age < 65 years), 187 elderly (age, 65-79 years), and 49 very elderly (age >/= 80 years). It was stopped because of side effects in 91 (23%) patients. Serious side effects occurred in 1.5% of the patients. There was a significant (60% +/- 35%) increase in heart rate, and a modest (10% +/- 19%) increase in the blood pressure (P <.001). The change in heart rate was similar in the three age groups, but there was a blunting of the blood pressure response with age. Hypotension was related to ischemia only in the very old. CONCLUSIONS: High-dose dobutamine is safe in all age groups. Dobutamine induces mainly a chronotropic and less a hypertensive response. The chronotropic response of the very old is similar with that of younger patients, but the hypertensive response is blunted in this group.