Issue 144 Item 6 Exercise-Induced Hypertension Flags Risk of Vascular Disease

Exercise-induced hypertension is a marker for vascular disease. Otherwise healthy adults with exercise-induced hypertension should receive aggressive cardiovascular risk-reduction therapies, including treatments to reduce their lipid levels and blood pressure, Dr. Lewis C. Becker said at the annual scientific sessions of the American Heart Association.

Although blood pressure is routinely measured during exercise ECG or exercise scintigraphy examinations, the readings are usually used only as a safety measure. Exercise tests are generally stopped if a person’s systolic blood pressure reaches 250 mm Hg, said Dr. Becker, professor of medicine at Johns Hopkins University in Baltimore. But pressures that reach 180 mm Hg or higher also have clinical significance.

He and his associates studied 521 apparently healthy, normotensive men and women with a mean age of 48. All were siblings of people who had coronary heart disease before age 60.

The subjects were considered to have exercise-induced hypertension if their systolic pressures were in the 90th percentile during exercise scintigraphy. This meant a systolic pressure of at least 186 mm Hg for African American men and at least 182 for white men. For African American women, the systolic pressure had to be at least 174 mm Hg and for white women, at least 162 mm Hg.

Among those with exercise-induced hypertension, the prevalence of left ventricular hypertrophy was 33%, compared with 14% in the others. The prevalence of a low ankle-brachial index was 40% in those with exercise-induced hypertension, compared with 18% in the others.

The people with exercise-induced hypertension also had greater amounts of carotid plaque and a larger left ventricular mass but did not show any abnormalities in their exercise ECG or thallium scan.

The researchers concluded that people with exercise-induced hypertension have an increased risk of peripheral vascular disease, carotid disease, and left ventricular hypertrophy, but are not at risk for coronary heart disease. This suggests that exercise-induced hypertension may be a precursor to or marker of significant vascular disease.