Elevated Blood Pressure in a High School Football Player: Case Presentation and Discussion

1990 ◽  
Vol 2 (4) ◽  
pp. 384-394
Author(s):  
Ted A Kaplan
Keyword(s):  
High School ◽  
Blood Pressure ◽  
Cardiovascular Response ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Football Player ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Elevated Systolic Blood Pressure ◽  
Graded Exercise

A case is presented of an adolescent high school athlete found to have mildly elevated systolic blood pressure (BP) at the preseason group physical examination. As part of the evaluation to clear him for participation, a graded exercise stress test was performed. The test revealed a systolic BP at peak exercise of 260 mm Hg. The rationale for hygienic and pharmacologic management of this situation is discussed, and the results of this process are detailed. This patient was finally treated with nifedipine after unacceptable results with lisinopril, pindolol, and nonpharmacological approaches. The graded exercise test can be a valuable part of the evaluation of a hypertensive athlete. Besides revealing the occasional dangerous superelevation of BP, the test results can reveal the individual’s cardiovascular response to stress. This can provide insight into the etiology of and prognosis for the patient’s problem. Follow-up testing should be done after any treatment is provided.

scholarly journals Effects of Atorvastatin on Resting and Peak Exercise Blood Pressure among Normotensive Men and Women

Cholesterol ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Amanda L. Zaleski ◽  
Marianne L. Mentch ◽  
Linda S. Pescatello ◽  
Beth A. Taylor ◽  
Jeffrey A. Capizzi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Stress Test ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Exercise Stress Test ◽  
Total Sample ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Exercise Blood Pressure ◽  
Double Blinded

Statins are the most widely prescribed and effective medication for reducing low density lipoprotein cholesterol. Statins may also lower resting blood pressure (BP); however, results are inconsistent. We sought to determine if the maximum dose of atorvastatin reduces resting BP and the peak systolic BP (SBP) achieved on a graded exercise stress test (GEST) among a large sample of 419 healthy men (48%) and women (52%). Subjects (419, 44.1±0.8 yr) were double-blinded and randomized to 80 mg·d−1 of atorvastatin (n=202) or placebo (n=217) for 6 mo. Among the total sample, there were no differences in resting BP (SBP, P=0.30; diastolic BP [DBP], P=0.69; mean arterial pressure (P=0.76); or peak SBP on a GEST (P=0.99)) over 6 mo, regardless of drug treatment group. However, among women on atorvastatin, resting SBP/DBP (3.7±1.5 mmHg, P=0.01/3.2±0.9 mmHg, P=0.02) and peak SBP on a GEST (6.5±1.5 mmHg, P=0.04) were lower versus men. Atorvastatin lowered resting BP 3-4 mmHg and peak SBP on a GEST ~7 mmHg more among women than men over 6 mo of treatment. The inconsistent findings regarding the antihypertensive effects of statins may be partially explained by not accounting for sex effects.

scholarly journals Exaggerated blood pressure response at mild exertional intensity is associated with lower exercise capacity and worsening of cardiac structural and functional profile

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.K Woznicka ◽  
M Kabaj ◽  
W Kosowski ◽  
J Zachwyc ◽  
R Pehcerczyk ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Exercise Capacity ◽  
Exercise Intensity ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Study Cohort ◽  
Funding Source ◽  
Cardiac Morphology

Abstract   Even with normal blood pressure (BP) measured at rest, some individuals may experience excessive BP elevation with exercise, termed as an “exaggerated BP response to exercise” (ExBPR). The most common definition of ExBPR is SBP ≥210 mm Hg in men and ≥190 mm Hg in women at peak exercise intensity (ExBPR-PI). However, evidence exists that increase in SBP ≥150 mm Hg at an early stage of exercise stress test (i.e. at mild exercise intensity, ExBPR-MI) can effectively identify hypertension not diagnosed by conventional methods. No studies exploring the pathophysiological significance of ExBPR-MI have been undertaken to date. Aim To investigate the association of ExBPR-MI with exercise capacity and cardiac morpho-functional characteristics. Methods A group of 109 subjects (mean age 52±13 yrs) with and without a pre-established diagnosis of hypertension, having clinical indications for an exercise stress test, with seated clinic BP <140/90 mm Hg, underwent resting echocardiographic imagining and cardiopulmonary exercise testing using a ramped Bruce protocol. Results Based on the BP response at 3 minutes of exercise, the population was divided into two subsets: ExBPR-MI+ and ExBPR-MI− (SBP ≥ and <150 mmHg, respectively). The ExBPR-MI+ group was characterized by lower peak oxygen uptake, higher LV mass and left atrial size, and more impaired LV diastolic function (lower E/A and e', and higher E/e'). When the study cohort was stratified using peak BP response, significant differences indicating an adverse impact of ExBPR-PI were demonstrated only for LV diastolic parameters but not for peak VO2 and cardiac morphology indices (Table 1). Conclusions ExBPR-MI predisposes to reduced exercise capacity and detrimental alterations in cardiac morphology and function. As mild exercise intensity is more frequently present during routine daily activities than peak exercise intensity, ExBPR-MI may be a more important pathophysiological contributor to target organ damage than peak BP response, and may represent a potential new target for preventive and therapeutic measures. Table 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Centre Poland

scholarly journals Systolic Blood Pressure Response to Exercise Stress Test and Risk of Stroke

Stroke ◽  
2001 ◽  
Vol 32 (9) ◽  
pp. 2036-2041 ◽  
Author(s):  
S. Kurl ◽  
J.A. Laukkanen ◽  
R. Rauramaa ◽  
T.A. Lakka ◽  
J. Sivenius ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blood Pressure Response ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Pressure Response ◽  
Exercise Stress ◽  
Response To Exercise

Blood pressure and risk of cognitive impairment. The role of vascular disease in neurodegeneration.

2019 ◽  
Author(s):  
Mar Carmona-Abellan ◽  
Malwina Trzeciak ◽  
Miriam Recio-Fernandez ◽  
Beatriz Echeveste ◽  
Laura Imaz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Stress Testing ◽  
Cardiovascular Response ◽  
Stress Test ◽  
Peak Exercise ◽  
Cardiac Stress ◽  
Cardiac Stress Testing

Abstract Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after the cardiac stress testing.Methods: This is a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015 and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period.Results: From this cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic and mean blood pressure than controls (p<0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise and both systolic and diastolic blood pressures increased significantly more during exercise. Conclusion: The results from this study suggest that differences in cardiovascular response to stress are present in the preclinical phase of cognitive decline, serving as a potential risk factor for cognitive impairment. These findings challenge the potential use of blood pressure and heart rate variability at rest and during cardiac stress assessment as a risk factor for cognitive impairment.

scholarly journals HEPATIC STEATOSIS IS INDEPENDENTLY ASSOCIATED WITH HYPERREACTIVE BLOOD PRESSURE RESPONSE ON THE EXERCISE STRESS TEST

2012 ◽  
Vol 59 (13) ◽  
pp. E1793
Author(s):  
Antonio Laurinavicius ◽  
Fernando Nary ◽  
Michael Blaha ◽  
Khurram Nasir ◽  
Raquel Conceicao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hepatic Steatosis ◽  
Blood Pressure Response ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Pressure Response ◽  
Exercise Stress

P4408Cardiovascular response in diabetic patients submitted to treadmill electrocardiographic exercise stress test

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Faia Carvalho Dias ◽  
M Oliveira ◽  
B Faria ◽  
P Von Hafe ◽  
A F Cardoso ◽  
...  
Keyword(s):  
Antihypertensive Drugs ◽  
Cardiovascular Response ◽  
Stress Test ◽  
Recovery Period ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Control Group ◽  
Diabetic Patients ◽  
Chronotropic Response ◽  
Response To Exercise

Abstract Introduction Diabetes mellitus (DM) is an entity commonly associated with neuropathy, a factor that may have repercussions on the cardiovascular system, specifically in its capacity to respond to stimuli. Objectives To evaluate the cardiovascular response to exercise in diabetic patients, comparing it with a control group. Methods Patients who underwent treadmill eletrocardiographic exercise stress test (EST) between January 2016 and November 2018 without the influence of negative chronotropic medication were included. Results A total of 187 patients were identified, having a mean age of 57±13 years, of whom 120 (64%) were of the male gender. Eighty-four (45%) were diabetic. The group of diabetic patients had a higher prevalence of arterial hypertension, however the number of classes of antihypertensive drugs was not significantly different between diabetic and non-diabetic patients. There were no significant differences in the remaining demographic variables. Patients with DM presented lower maximal heart rates (HR) (141±14 vs 148±19 beats/minute, p=0.015), lower HT reserve (59±16 vs 67±21 beats/minute, p=0.005), as well as a lower rate of HR fall in the recovery period (13±5 vs 16±5 beats/minute2, p<0.001). Total EST time was also lower in diabetic patients (median 7.0 IQR=3 vs 7.3 IQR=3.5 minutes, p=0.044). Additionally, the number of years since the time of diagnosis of DM was inversely correlated with the degree of increase in systolic blood pressure (SBP) with exercise (r=−0.22, p=0.045), and the pre-test SBP (median 135 IQR=24 vs 130 IQR=20 mmHg, p=0.048) and post-test SBP (median 150 IQR=20 vs 140 IQR=25 mmHg, p=0.007) were higher in patients with DM. Discussion In this study it was found that patients with DM present an impaired chronotropic response, both in exercise and recovery periods, and it was observed that the capacity to increase SBP is inversely correlated to the duration of DM. These data may reflect the neuropathic involvement in DM and its influence in the cardiovascular response to exercise.

scholarly journals Coagulation and inhibitory and fibrinolytic proteins in essential hypertension.

1993 ◽  
Vol 4 (2) ◽  
pp. 222-228
Author(s):  
N D Vaziri ◽  
D H Smith ◽  
R L Winer ◽  
M A Weber ◽  
E C Gonzales ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Coagulation ◽  
Plasminogen Activator ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Tissue Plasminogen ◽  
D Dimer

Arterial hypertension (HTN) increases the risk of cerebral coronary, and other vascular complications that frequently involve platelet activation and blood coagulation. Several key proteins in the blood coagulation, fibrinolytic and inhibitory systems were studied in 29 men with HTN (aged 45 +/- 3 yr) and 15 normal men of the same age. Plasma levels of high-molecular-weight kininogen and factors XII, IX, VII, X, II, and XIII, as well as von Willebrand factor (vWF), fibrinogen, fibronectin, alpha 2-antiplasmin, tissue-plasminogen activator, D-dimer, platelet factor-4, and protein C were measured by the use of appropriate functional and immunologic assays before and after a cardiopulmonary exercise stress test. The concentrations of vWF, alpha 2-antiplasmin, and D-dimer were significantly (P < 0.02) higher in the HTN group as compared with the control group. The exercise stress test resulted in significant rises in the plasma vWF, alpha 2-antiplasmin, and tissue-plasminogen activator levels in the two groups. The concentrations of vWF and D-dimer were related to diastolic blood pressure (r = 0.44 and 0.40, respectively; P < 0.02). Levels of vWF also were related to left ventricular mass index and left ventricular posterior wall and septal thickness (r = 0.34, 0.43, and 0.34, respectively; P < 0.05). The constellation of these findings suggests a low-grade fibrin formation and degradation, the magnitude of which is related to the diastolic blood pressure. The observed abnormalities can potentially contribute to the cardiovascular complications of untreated HTN.

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