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Heart Disease (Expert Forum)
Treating exercise systolic hypertension that let to LVH
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Treating exercise systolic hypertension that let to LVH
by Stanley Terman, Mar 10, 2000 12:00AM
I am 57 y-o psychiatrist, and in excellent physical conditioning: I can do hard tennis drills, raising my heart rate to above 160 for 2 hours a day, 5 to 7 days a week, with only intermittant rests to recover my breath. I am on FlowMax for BPH beneign hypertrophy of the prostate) (0.8 mg).
A recent echo: mild to moderate concentric LVH
Stress test: exaggerated systolic response to excercise (225/90 @ HR of 155) on the Bruce protocol.
Questions:
1) could FlowMax be part of the culprit, given the recent bad news about Cardura, another alpha blocker?
2) If Prinivil 10 mg has little effect, and 20 mg leads to resting hypotension and dizziness on the tennis court (which is why I stopped taking the drug 4 years ago), what second drug should be tried? Would a beta-blocker make more sense than 12.5 of hydrochlorthiazide?
3) How much should I worry about my LVH, given no ischemia at a HR of 155? Is it reversible? Should I monitor my HR on the tennis court?
4) Any other advice?
A recent echo: mild to moderate concentric LVH
Stress test: exaggerated systolic response to excercise (225/90 @ HR of 155) on the Bruce protocol.
Questions:
1) could FlowMax be part of the culprit, given the recent bad news about Cardura, another alpha blocker?
2) If Prinivil 10 mg has little effect, and 20 mg leads to resting hypotension and dizziness on the tennis court (which is why I stopped taking the drug 4 years ago), what second drug should be tried? Would a beta-blocker make more sense than 12.5 of hydrochlorthiazide?
3) How much should I worry about my LVH, given no ischemia at a HR of 155? Is it reversible? Should I monitor my HR on the tennis court?
4) Any other advice?
Doctor's Answer
by CCF CARDIO MD JMF, Mar 10, 2000 12:00AM
Dear Stanley.
One general comment. For maximal cardiovascular fitness you should exercise at noi more than 85% of your maximum predicted herat rate. This would calculate out to 85% of (220 minus your age) this would be 138 beats per minute. The fact that you do prolonged episodes of exercise at maximal heart rates may have predisposed to the development of LVH.
In response to your specific questions regarding your systolic hypertension:
1)could FlowMax be part of the culprit, given the recent bad news about Cardura, another alpha blocker? Not likely. Although, other agents may be more useful in the setting of LVH including a beta blocker.
2) If Prinivil 10 mg has little effect, and 20 mg leads to resting hypotension and dizziness on the tennis court (which is why I stopped taking the drug 4 years ago), what second drug should be tried?
You may want to try a smaller dose of a different ace inhibitor with a slightly shorter half life. Would a beta-blocker make more sense than 12.5 of hydrochlorthiazide? You may want to consider a beta blocker in combination with HCTZ
3) How much should I worry about my LVH, given no ischemia at a HR of 155? Is it reversible? Should I monitor my HR on the
tennis court? Please see my above comments.
4) Any other advice? I would not change any of your medications until you are completely examined by your physician and these questions are addressed directly to them. I would also recommend a formal exercise prescription and evaluation for the maximal benefit of exercise in your case.
One general comment. For maximal cardiovascular fitness you should exercise at noi more than 85% of your maximum predicted herat rate. This would calculate out to 85% of (220 minus your age) this would be 138 beats per minute. The fact that you do prolonged episodes of exercise at maximal heart rates may have predisposed to the development of LVH.
In response to your specific questions regarding your systolic hypertension:
1)could FlowMax be part of the culprit, given the recent bad news about Cardura, another alpha blocker? Not likely. Although, other agents may be more useful in the setting of LVH including a beta blocker.
2) If Prinivil 10 mg has little effect, and 20 mg leads to resting hypotension and dizziness on the tennis court (which is why I stopped taking the drug 4 years ago), what second drug should be tried?
You may want to try a smaller dose of a different ace inhibitor with a slightly shorter half life. Would a beta-blocker make more sense than 12.5 of hydrochlorthiazide? You may want to consider a beta blocker in combination with HCTZ
3) How much should I worry about my LVH, given no ischemia at a HR of 155? Is it reversible? Should I monitor my HR on the
tennis court? Please see my above comments.
4) Any other advice? I would not change any of your medications until you are completely examined by your physician and these questions are addressed directly to them. I would also recommend a formal exercise prescription and evaluation for the maximal benefit of exercise in your case.
One general comment. For maximal cardiovascular fitness you should exercise at noi more than 85% of your maximum predicted herat rate. This would calculate out to 85% of (220 minus your age) this would be 138 beats per minute. The fact that you do prolonged episodes of exercise at maximal heart rates may have predisposed to the development of LVH.
In response to your specific questions regarding your systolic hypertension:
1)could FlowMax be part of the culprit, given the recent bad news about Cardura, another alpha blocker? Not likely. Although, other agents may be more useful in the setting of LVH including a beta blocker.
2) If Prinivil 10 mg has little effect, and 20 mg leads to resting hypotension and dizziness on the tennis court (which is why I stopped taking the drug 4 years ago), what second drug should be tried?
You may want to try a smaller dose of a different ace inhibitor with a slightly shorter half life. Would a beta-blocker make more sense than 12.5 of hydrochlorthiazide? You may want to consider a beta blocker in combination with HCTZ
3) How much should I worry about my LVH, given no ischemia at a HR of 155? Is it reversible? Should I monitor my HR on the
tennis court? Please see my above comments.
4) Any other advice? I would not change any of your medications until you are completely examined by your physician and these questions are addressed directly to them. I would also recommend a formal exercise prescription and evaluation for the maximal benefit of exercise in your case.
I read today about a new Systolic Hypertension medication named,"Teveten"(Eprosartan Mesylate). This medication, which is a chemically modified version of Losarten("Cozaar"), has demonstrated a SNS(Sympathetic Nervous System)effect. It might be worth your while to research this medication, and when you discuss your medications with your doctor it might be a viable alternative to treat your Systolic Hypertension. I am a layman, and am writing because I read about this today and thought it was relevant to your situation.
Sincerely,
Ginny