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Heart Disease (Expert Forum)
Exaggerated b/p response to exercise???
Answered by
Cleveland - OH
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Exaggerated b/p response to exercise???
by Krp1942, Mar 28, 2004 12:00AM
An excellent forum...thank you.
I am a 61 year old female with asthma and osteo-arthritis. In 2000 I developed HTN,b/p went to 201/108, and for 2-3 minutes my left hand was numb. Seemed like a TIA to me. I had a cardiac cath..results: nonobstructive coronary artery disease,and normal left ventricular function. I had a cartoid doppler...results: left & right internal carotids stenosis of 20-30%. The doctor prescribed an ARB w/htcz and statin. I lost 60 lbs. and now exercise regularly.
For location convenience, I changed cardiologist 2002. On 9/03 I was reevaluated with a renal scan and stress echocardiogram. Results: 1)renal okay 2)Bruce Protocol, achieved 89% of maximal heart rate with no chest pain, no evidence of exercise-induced ischemia,no arrhythmias, normal function capacity, no doppler evidence of diastolic dysfunction. The doctor changed my medications..eliminated ARB. She tried diltiazem er, norvasc,aldomet. I am having many side effects: fatigue, edema,ankles,light anxiety,headache...too tired to exercise. Now on dilitazem er/w htcz. Frustrated, why change my medication? The ARB w/htcz med did not control my b/p during exercise. Add'l, I had these results...
resting b/p 134/95 3 min 180/85 hr 86
6 min 205/85 hr 117
8 min 130/95 hr 143 recovery 141/79
Question: 1) Did walking and light weights really help my b/p?
2) How abnormal is my b/p during exercise?
3) Are CCB's my only choice now?
4) Any help to decrease side effects?
I am a 61 year old female with asthma and osteo-arthritis. In 2000 I developed HTN,b/p went to 201/108, and for 2-3 minutes my left hand was numb. Seemed like a TIA to me. I had a cardiac cath..results: nonobstructive coronary artery disease,and normal left ventricular function. I had a cartoid doppler...results: left & right internal carotids stenosis of 20-30%. The doctor prescribed an ARB w/htcz and statin. I lost 60 lbs. and now exercise regularly.
For location convenience, I changed cardiologist 2002. On 9/03 I was reevaluated with a renal scan and stress echocardiogram. Results: 1)renal okay 2)Bruce Protocol, achieved 89% of maximal heart rate with no chest pain, no evidence of exercise-induced ischemia,no arrhythmias, normal function capacity, no doppler evidence of diastolic dysfunction. The doctor changed my medications..eliminated ARB. She tried diltiazem er, norvasc,aldomet. I am having many side effects: fatigue, edema,ankles,light anxiety,headache...too tired to exercise. Now on dilitazem er/w htcz. Frustrated, why change my medication? The ARB w/htcz med did not control my b/p during exercise. Add'l, I had these results...
resting b/p 134/95 3 min 180/85 hr 86
6 min 205/85 hr 117
8 min 130/95 hr 143 recovery 141/79
Question: 1) Did walking and light weights really help my b/p?
2) How abnormal is my b/p during exercise?
3) Are CCB's my only choice now?
4) Any help to decrease side effects?
Doctor's Answer
by Cleveland Clinic, Mar 28, 2004 12:00AM
, Mar 28, 2004 12:00AM
krp,
1) Lifestyle modification in those with alot of modifiable risk factors (overwieght, diet, smoking) can have significant impact on blood pressure. So yes, I think it probably had a pretty big impact on your BP.
2) The normal exercise response in exercise testing is to increase your systolic blood pressure progressively with increasing workloads to a peak response ranging from 160 to 200 mm Hg. Older patients tend to have values in the higher range of the scale because of decreased compliance of their vascular systems. So you BP change isn't really that abnormal.
3) No, I would seriosly consider changing back to an ARB or ACE, and the diuretic, then adding on other medications only when maximal doses of those agents are reached. I really consider a CCB as a 2-3 line agent after diuretics and ace inhibitors unless there are specific reasons not to use those medications.
4) Those medications shouldnt really impact your energy level too much. They can cause swelling and edema (CCB) that is not responsive to the diuretic. Again, I would think about losing the CCB. I would also suggest looking for other reasons for your fatige and light headedness as those shouldnt be associated with the CCB.
good luck!
1) Lifestyle modification in those with alot of modifiable risk factors (overwieght, diet, smoking) can have significant impact on blood pressure. So yes, I think it probably had a pretty big impact on your BP.
2) The normal exercise response in exercise testing is to increase your systolic blood pressure progressively with increasing workloads to a peak response ranging from 160 to 200 mm Hg. Older patients tend to have values in the higher range of the scale because of decreased compliance of their vascular systems. So you BP change isn't really that abnormal.
3) No, I would seriosly consider changing back to an ARB or ACE, and the diuretic, then adding on other medications only when maximal doses of those agents are reached. I really consider a CCB as a 2-3 line agent after diuretics and ace inhibitors unless there are specific reasons not to use those medications.
4) Those medications shouldnt really impact your energy level too much. They can cause swelling and edema (CCB) that is not responsive to the diuretic. Again, I would think about losing the CCB. I would also suggest looking for other reasons for your fatige and light headedness as those shouldnt be associated with the CCB.
good luck!
