Hypertensive Response to Maximal Exercise Test in Young and Middle Age Hypertensive on Blood Pressure Lowering Medication: Monotherapy vs. Combination Therapy
Background: Hypertensive response during maximal exercise test provides important information on the level of blood pressure control and evaluation of treatment. Method: A single center retrospective descriptive study was conducted among 117 young (aged 20 to 40) and middle age (aged 40 to 65) hypertensive patients, who underwent treadmill stress test. Currently on maintenance frontline medication either monotherapy (Angiotensin-converting enzyme inhibitor/Angiotensin receptor blocker [ACEi/ARB], Calcium channel blocker [CCB], Diuretic - Hydrochlorthiazide [HCTZ]) or combination therapy (ARB+CCB, ARB+HCTZ), who attained a maximal exercise on treadmill stress test (TMST) with hypertensive response (systolic blood pressure: male >210 mm Hg, female >190 mm Hg, diastolic blood pressure >100 mmHg, or increase of >10 mm Hg at any time during the test), on Bruce and Modified Bruce protocol. Exaggerated blood pressure response during exercise (systolic [SBP] and diastolic [DBP]), peak exercise blood pressure (SBP and DBP), recovery period (SBP and DBP) and test for ischemia and their antihypertensive medication/s were investigated. Analysis of variance and chi-square test were used for statistical analysis. Results: Hypertensive responses on maximal exercise test were seen mostly among female population (P < 0.000) and middle age (P < 0.000) patients. Exaggerated diastolic blood pressure responses were significantly lower in patients who were taking CCB (P < 0.004). A longer recovery period that showed a delayed decline in SBP was observed in patients taking ARB+HCTZ (P < 0.036). There were no significant differences in the level of exaggerated systolic blood pressure response and during peak exercise (both systolic and diastolic) in patients using either monotherapy or combination antihypertensives. Conclusion: Calcium channel blockers provided lower exaggerated diastolic BP response during maximal exercise test in hypertensive middle age patients. Patients on combination therapy using ARB+HCTZ exhibited a longer recovery period of systolic blood pressure.
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 Froelicher VF, Myers JN. “Exercise and the Heart”. Philadelphia, PA, WB Saunders, 2000.
 Schultz MG, Hare JL, Marwick TL, et al. “Masked Hypertension is ‘unmasked’ by low-intensity exercise blood pressure”. Blood Press 2011; 20:284-289.
 Nwankwo T, Yoon SS, Burt V, Gu Q. “Hypertension Among Adults in the United States: National Health and Nutrition Examination Survey”. 2011–2012. NCHS Data Brief; 2013.no. 13.
 Sieira MS, Ricart AO, Estrany RS. “Blood pressure response to exercise testing”. Apunts Med Esport. 2010;45(167):191-200.
 Jong-Chan Youn, Seok-Min Kang. “Cardiopulmonary Exercise Test in Patients with Hypertension: Focused on Hypertensive Response to Exercise”. Pulse. 2015;3:114–117J.
 Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. “Heart-Rate Recovery Immediately After Exercise as a Predictor of Mortality”. New England Journal of Medicine. 1999; 341: 1351-1357.
 Uchecchukwu D, Ugwu A. “Determination of Systolic Blood Pressure Recovery Time after Exercise in Apparently Healthy, Normotensive, Nonathletic Adults and the Effects of Age, Gender and Exercise Intensity”. Int J ExercSci 2(2). 2009:115-130.
 James PA, Ortiz E et al. “2014 evidence-based guideline for the management of high blood pressure in adults: (JNC8).” JAMA. 2014 Feb 5; 311(%):507-520
 MacKay JH, Arcuri KE, Goldberg AI, Snapinn SM, Sweet CS, “Losartan and low dose hydrochlorthiazide in patients with essential hypertension: A double-blind, placebo-controlled trial of concomitant administration compared with individual components.” Arch Intern Med. 1996: 156: 278-85.
 Boutouyrie P, Achouba A, Trunet P, Laurent S, for the EXPLOR trialist group. “Amlodipine-Valsartan Combination Decreases Central Systolic Blood Pressure More Effectively Than the Amlodipine-Atenolol Combination The EXPLOR Study.” Hypertension. 2010;55:1314-1322.
 Billecke S, Marcovitz P. “Long term safety and efficacy of telmisartan/amlodipine single pill combination in the treatment of hypertension.” Vascular Health Risk Management. 2013;9:95-104.
 Douglas L Mann, MD, Douglas P. Zipe, MD, Peter Libby, MD, Robert O. Bonow, MD. “Braunwald’s Heart Disease, A Textbook of Cardiovascular Medicine, 10th edition, Vol. 1. 2015:161.
 Shim CY, Ha JW, Park S, Choi EY, Choi D, R SJ, et al. “Exaggerated Blood Pressure Response to Exercise Is Associated with Augmented Rise of Angiotensin II During Exercise.” Journal of the American College of Cardiology. (JACC) Vol. 52, No. 4, 2008:287–92.
 Laukkanen JA, Kurl S, Salonen R, Lakka TA, Rauramaa R, Salonen JT. “Systolic Blood Pressure During Recovery From Exercise and the Risk of Acute Myocardial Infarction in Middle-Aged Men”. Hypertension. 2004; 44:820-825.
 McHam SA, Marwick TH, Pashkow FJ, Lauer MS. “Delayed Systolic Blood Pressure Recovery after Graded Exercise, an independent correlate of angiographic coronary disease”. Journal of the American College of Cardiology. 1999. Vol. 34, No. 3;755-759.
 Schultz MG, Otahal P, Cleland VJ, et al.: “Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis”. Am J Hypertens. 2013;26:357-366.
 De Queiroz Carreira MA, Ribeiro JC, Caldas JA, Tavares LR, Nani E. “Response of Blood Pressure to Maximum Exercise in Hypertensive Patients under Different Therapeutic Programs”. Arq Bras Cardiol, volume 75 (no 4). 2000:285-288.