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Exercise induced hypertension
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Exercise induced hypertension

Happy Easter! I am a 57 man who has posted before. I was shocked 3 years ago to find I had an LAD blockage at the bifurcation that was bypassed with the LIMA and a venous graft. It has been my obsession for the last three years to understand what caused it in the absense of family history, smoking, BP, high cholesterol, etc. I have been a very heavily involved in running, cycling, and racing for the last 35 years. My cardiologist is likewise baffled that someone with HDL of 60 would have CAD.
In my last visit, I suggested to him that all my stress tests have noted exercise induced hypertension, with my systolic hitting 225 to 230 at peak workload. I wondered whether this could have been a factor in the blockage. He didn't know, but offered to do an echo to compare with a 2 and 4 yo echos to see if there have been any changes. Indeed there was! Comparing to a 4 year echo, my posterior ventricular wall along with the septum have marched steadily upward from high normal of 1.0 cm to 1.5 cm. He put me on Zestril (ACE inhibitor) in spite of some info I had dug up on the internet saying that Norvasc (calcium antagonist) was the first line treatment for exercise induced hypertension. He said Zestril has been shown to reverse LVH and wanted to go that way.
Comments? Is it possible that I was the unknowing author of my own problems with all the heavy exercise? Do I need to cut my exercise volume and intensity now? Is Zestril the best approach? I can't get past the feeling every time I work out that I am shortening my lifespan rather than prolonging it.
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Hi Tom,

Try to be too obsessed by your CAD.  There are somethings we just don't understand yet and CAD in people with no apparrent risk factors is one of them.   There is no clear answer.

He said Zestril has been shown to reverse LVH and wanted to go that way.  Comments?

I am not familiar with data suggesting that norvasc is first line for exercise induced hypertension. Is the from a reputable journal, is a randomized study?  I think an ACEI is reasonable.

Is it possible that I was the unknowing author of my own problems with all the heavy exercise?

I have never read anything to suggest that heavy exercise increase the risk of CAD.


Do I need to cut my exercise volume and intensity now?

Again, there is not data to suggest this would help decreae your risk of further CAD.  Usually too much exercise is not our concern, most people are under rather than over active.

Is Zestril the best approach? I can't get past the feeling every time I work out that I am shortening my lifespan rather than prolonging it.

It is good quetions, there is no clear answer that I know off.  This would be very difficult to organize a randomized trial.

Sorry I can't be of more help.  Thanks for posting.
11 Comments
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Avatar_n_tn
To the doctor, Al Dente, and anacyde,
Thank you for your comments. They are very helpful to at least know that someone appreciates my plight. I guess one of my biggest fears is that I will end up looking like a fool in that friends and family who are more moderate exercisers have always thought my exercise habits to be a bit extreme (although in my circle of riding and running companions I am certainly not). The other thing is through this forum and by casual aquaintance I have run into a number of others in a situation similar to mine-am I like the guy who figured out that ulcers were caused by a virus? At this point I am just looking for the know to turn that will arrest my CAD and allow me to continue my favored activities.
   I have read the literature and many studies about ACEIs and CCB's. For now, I will follow the doc's recommendations. I will be pushing for a followup echo at my next visit, although six months may be too early to see any progress.

Tom
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Avatar_n_tn
Tom,

I am in the same boat. No history, triathalons, eat right, no smoking or drinking. BUT the collateral vessels around my LAD blockageclearly saved my life from my initial MI. They performed wonderfully again several months ago when my stent restenosed after 2 years. The only clue I had was nausea during a hard training run.

HAd the cath done in mid February and 1 month later I was back up to my original miles.

I don't see any real drop of with exercise except I limit my weights to 125lbs and my speed work HR needs to stay in the 170 range.

Otherwise, keep doing the stress testing, eating right and have fun.
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Avatar_n_tn
Interesting posting here.

I too have exercise/stress induced hypertension.  The first time I was aware of this was during a Stress Thallium when they ended the test with a BP of 220/65.  I had no chest pains during this rise on the threadmill but had a horrid headache. I was not given any BP meds then but I should of been.

I was told to tell any doctor/anesthesiolgists about this rise in BP should I ever have surgery as this can happen again with surgery.

Well, I forgot and a year later, I had a kidney stone removed and had a general. What should of been an out patient procedure was all but this. In the recovery room, I would not wake up and my BP was 220/60 again for hours. No one bothered calling in the anesthesiolgist or the kidney doctor and I was pumped full of Benydryl. I was admitted for overnight (fellow on call made that call).  The next morning I looked in the mirror and my lips were blue. I asked about this but never got a straight answer. This is when I think I had my heart attack. I was not EKG'd monitored for the overnight stay so there was no way to know on paper. (I think blue lips mean lack of oxygen)

What I am getting at is that "any" kind of stress can bring up the BP if one is prone. Even driving the car in heavy traffic, I was told.

I also now have stents in the LAD and RCA.  I was told it was caused by years of undiagnosed elevated BP that was not treated.
I then got all copies of back EKG's from years earlier and took them to another doctor. He spotted that starting in 2000, the EKG's listed as normal showed LVH....thus contributing to the blockages and now an obstruction in the Left Ventricle.

Mantels:  You mentioned Collaterals. How did they find these?

I have asked my Cardiolgist about these and he approached the Cath doctor to review his cath on tape to see if I was growing collaterals in the distal LAD where the severe blcokage is (Heart attack area) but the Cath doctor told him he did not have the time to do it and asked the GP to do it....The general Cardio doctor said he did not know how to read the Cath disk.  I am now in Limbo.

Mantels:  You mentioned that your stent restenosed after 2 years.  Was this a Coated stent or a bare metal stent?  Were you on Plavix the whole time and the stent closed up?  I am still on Plavix (18 months now) but would like to get off that stuff.

Thanks for any help...


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Avatar_n_tn
Only took Plavix for 12 months with original stent. Original stent was bare metal because at the time of my MI in 2003, medicated was not used for MI issues. (or so I'm told)

I will stay on Plavix as long as they let me.
I bleed alot if cut, but restonosis is worse.

I was told by genetisist that sometimes the arteries of the heart get roughened up bu having a virus early in life. In my early 20's I had a real bad case of mono. It could be true. It is the only risk factor I have found.

I have been running for 30 years and over that time the collterals have grown. My heart cath dr. told me. I ran with an MI for several miles and I ran 2 months ago with a 100% clogged LAD. So thank goodness for collaterals.

All those years of work on the roads and track paid off. Not necessarily with the times i wanted but they probably saved my life, twice.
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Avatar_n_tn
Thanks for this information.

Yes, restonosis is worse than the Plavix but with Plavix they are now finding yes, it keeps the stents open but it also harbors the growth of new healing cells.

Plavix is also a surgeon's nightmare if they have to do surgery for any reason on a Plavix patient.  I have to be off Plavix for 5 days next month to control bleeding and cardio is concerend that being off will trigger 'soemthing'...)-:

I am sending my heart cath disks to another heart center and they will view them to see if collaterals are growing. My Cath doctor said he was tooooo busy to view the cath disk and does not remember if he saw collaterals or not.   He wins the award for being the nicest, kindness, compassionate, level headed, Cardiolgist in the country.  RIGHT!~!  He needs a spanking. LOL

Wishing you good days ahead.
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Avatar_n_tn
Regarding your wish to know whether you are developing collaterals, perhaps you are obsessing in the same way I obsess over what caused my CAD. I think your symptoms should probably tell you whether you are ischemic or not.
   I actually had a well developed collateral network, probably from the years of running. I remember the cardiologist remarking during the cath about all the collaterals but then tempering my joy saying that is often a bad sign-they often indicate a blockage on the other side of the heart. Turned out to be true. I guess they are responsible for my only symptom being mild sob in the early blocks of running. I would not have had a clue to my blockage based on the way I felt on the bike.
   I have read somewhere that collaterals never carry enough blood to perfuse the heart well during periods of exertion-only at rest. The surgeon also told me they tend to shrink back and essentially disappear when the heart is re-vascularized as in CABG or stenting.
   I think the "use it or lose it" motto applies to coronary vessels. I have been told that they will normally not graft vessels that are less than 70% occluded as they will quickly block up due to the native vessels still supplying the majority of the blood (and the flow rate being rather small in the graft). Therefore, my modus operandi is to keep those pipes full and flowing fast through exercise.
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Avatar_f_tn
When my husband had his stress test his BP went up to 227 syst. and the Cardiologist told the nurse to "continue" monitoring.  Afterwards he talked to my husband and me.  My husband was concerned why his BP shot up to 227, and the Cardiologist said "don't worry, I wanted it that high", and then he said a study was made one time with weight lifters, they had BP monitors attached to them while they were doing heavy weight lifting, and their BP shot as high as 240 and 250 syst.  The Cardiologist said there have not been any reports of weight lifters having a stroke or sudden death during weight lifting, and that it was NORMAL for your BP to shoot that high when heavy exercising, and a stress test is heavy exercising.
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Hi all, I am new here so please forgive me if I go in a wrong direction, ok?  My CAD seems to be acting up again. Not sure though since I have other conditions which have similar symptoms.(GERD,cervical myelopathy, etc) Normally my BP is considered low. Most of my life, and that of most of family is also low. 112/65  sometimes 125/74 etc. I currently have two stents in the LAD, the last one in 2003, drug effusing, near the apex. The first in 2000 near the mid LAD. During the 2003 procedure, I experienced an MI, mild.(the stent/ballon that wouldn't deflate was used) All of a sudden this week my BP has shot up to 187/97. Taken it about 4 times, one after resting in bed, 147/93 that was the lowest one. Unlike you, I am not good exerciser, due to a spinal cord injury. Not paralyzed, but, limited in mobility at times.

As far as CAD I do have all of the risk factors, which is also different from your posts. Family, cholesterol, high lipids, overweight, etc, I wonder if collaterals grow in these conditions too?
Have to call my cardio to let him know about the new BP this week. I used to be on med's for it after last MI/Stent, but got off about a year ago. It had gone down to normal range, (low) for me. Now it is up, probably clogging up again. Darn it. I am still on aspirin and plavix. Thanks for being there,
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Avatar_n_tn
I am 35 years old male . I had been diagnosed with hypertension . I am on medicing metaprolol 25 mg (morning and evening ) and Ditide in the morning .. I want to know if running on treadmill is good for heart and to reduce hypertension .

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Avatar_n_tn
I am 35 years old male . I had been diagnosed with hypertension in apr 07 . I am on medicine metaprolol 25 mg (morning and evening ) and  one tablet Ditide in the morning and 20mg lovastatin in the evening . My height is 5.5 ft and my weight is 83kg . I am overweight by 20 Kg . I have joined gym to reduce weight . My instructor has advise me not to run on treadmill as it increases heart rate . My BP is now under 140 / 90 . Some times it crosses 140/90

I am looking for answers for following questions

1) Wheather running on treadmill is good or bad for clinically diagonosed hypertensive patients. My instructor has advise not to run on treadmill.

2) I used to do heavy workout with weights earlier . Is heavy workout with weights in gym is good for hypertensive people.

3) I do workout ( aerobics and weight  training ) and spend 60 to 90 mins in gym . But my heart rate is always above 90 beats/min 2 hrs after I finish my workout . Is this OK .  My resting heart rate in the morning around 0630 hrs is 65 beats/min and I am on drugs mentioned earlier. Is my heart recovery rate is OK .

4) I have come accross one device called resperator which is controlled breating . Is it really good for BP patients.

5) With medication on I am still not be able to achieve 120/80 BP . Is the doses recommended by my doctor ( Metaprolol 25 mg (morning, evening) and Ditide (one tab in the morning) , Lovastatin (20mg before sleep ) is OK .

6) My mother age 58 is hypertensive for past 10 years and My younger brother 33 is hypertensive for past 2 years and suffered stroke in young also in Feb 07 .

7) Should i start taking medicine along with BP drugs which will not allow blood to clot in the event of stroke. Disprin (asprin) do not allow clotting of blood . Please suggest

Awaiting your reply
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