Exercise Related Hypertension (ERH) may not be a Benign Phenomenon

Blood pressure increases with exercise. A systolic blood pressure (SBP) ≥ 200 mmHg is considered pathological.

We recently observed a 78 year old male who suddenly noticed loss of speech while walking uphill. He was diagnosed as a non blood clot embolic stroke. The source of embolization was thought to be a calcified plaque at the origin of the left carotid artery. On subsequent Ambulatory BP monitor he had resting SBP of 150. We assumed that with baseline hypertension (HTN) he increased his SBP on exercise, possibly dislodging an aortic plaque.

Thus we went to our records to explore patients treated for exercise related HTN (ERH). Patients with ERH (defined as normal resting SBP and SBP > 200 on exercise) we implemented a preventive measure and placed on low dose beta block (BB) or baseline BB dose was increased or additional low dose non-BB med was used. Fine dose titration was necessary to avoid compromise of resting SBP. Each patient had follow-up (FU) treadmill (TM) tests to assess efficacy of treatment.

Results: We found 16 (11 male) patients with ERH, mean age 61.8 (standard deviation (SD) 8.8). 143 TM tests (16 baseline, 127 FU) were done. Mean baseline resting SBP was 127.4 (SD 8.4) and peak SBP was 208.8 (SD 10.2). Upon treatment, mean FU resting SBP was 123.8 (SD 11.5) and mean FU peak SBP was 173.1 (SD 22.5). On FU, 71% (90 FU tests) of peak SBP dropped by ≥ 30, with 84% (106) < 200. 56% of patients (9) had peak SBP < 200 on all FU tests.

Conclusion: ERH , which may not be a benign phenomenon,can be controlled effectively using low dose BB (or other low dose med) without compromising normal resting SBP.