Exercise Induced Hypertension?

M'ohms · Post by **M'ohms** » Sat Feb 21, 2015 6:57 am

Wanting to find out if I had heart problems due to sleep apnea, I had a stress test done yesterday. The doc stopped the test after a few minutes even though I was doing just fine. He told me that my BP went from normal range to >190/120 in just a few minutes and dx'd me with Exercise Induced Hypertension. I've never heard of this and wonder if it is a result of an oxygen starved heart. He is starting me on 25 mg Metoprolol Succinate ER. I haven't been able to find out much about this. Does anyone have any experience/knowledge about this? EKG, echo, and electrical heart function are all normal.

Julie · Post by **Julie** » Sat Feb 21, 2015 7:13 am

I'd want to ask the doctor about this, but you could always Google 'Etiology of Exercise Induced Hypertension' to get some quick ideas.

It doesn't sound like an unlikely dx though, and it would be interesting if Cpap lowered your BP as it often does with others. One thing I would talk to the MD about is what the meds may do to your sleep/Cpap, etc. You might also want to Google the side FX of it to see what they say.

49er · Post by **49er** » Sat Feb 21, 2015 8:16 am

M'ohms wrote:Wanting to find out if I had heart problems due to sleep apnea, I had a stress test done yesterday. The doc stopped the test after a few minutes even though I was doing just fine. He told me that my BP went from normal range to >190/120 in just a few minutes and dx'd me with Exercise Induced Hypertension. I've never heard of this and wonder if it is a result of an oxygen starved heart. He is starting me on 25 mg Metoprolol Succinate ER. I haven't been able to find out much about this. Does anyone have any experience/knowledge about this? EKG, echo, and electrical heart function are all normal.

Hi M'ohms,

I suspect I have this based on a few blood pressure measurements after taking an extensive walk. But I couldn't find any clear indication as to the best way to proceed.

Regarding you being prescribed with the metoprolol, if your blood pressure is normal range other than when you exercise, wouldn't that drag it down to a too low number? What was your doctor's reasoning for prescribing this particular med. vs. not doing anything. vs. another med?

Thanks!

49er

49er · Post by **49er** » Sat Feb 21, 2015 8:19 am

Julie wrote:I'd want to ask the doctor about this, but you could always Google 'Etiology of Exercise Induced Hypertension' to get some quick ideas.

It doesn't sound like an unlikely dx though, and it would be interesting if Cpap lowered your BP as it often does with others. One thing I would talk to the MD about is what the meds may do to your sleep/Cpap, etc. You might also want to Google the side FX of it to see what they say.

FYI about alpha and beta blockers:

http://www.aarp.org/health/drugs-supple ... omnia.html

49er

Sheffey · Post by **Sheffey** » Sat Feb 21, 2015 9:34 am

M'ohms wrote:He is starting me on 25 mg Metoprolol Succinate ER.

Did he talk to you about lifestyle changes?

M'ohms · Post by **M'ohms** » Sat Feb 21, 2015 10:35 am

Julie wrote:I'd want to ask the doctor about this, but you could always Google 'Etiology of Exercise Induced Hypertension' to get some quick ideas.

It doesn't sound like an unlikely dx though, and it would be interesting if Cpap lowered your BP as it often does with others. One thing I would talk to the MD about is what the meds may do to your sleep/Cpap, etc. You might also want to Google the side FX of it to see what they say.

Initially my BP went from borderline high to between 110-120/70-80, well within normal range. It is still like that except for physical exertion. I did talk to him about the drug causing sleep disturbances, and with my SA, I wasn't eager to try it. It was left with me trying it for 2 weeks and reporting beck to him with my tolerance of it. If I don't tolerate it well enough, I don't know what the next step will be.

M'ohms · Post by **M'ohms** » Sat Feb 21, 2015 10:43 am

[/quote]Hi M'ohms,

I suspect I have this based on a few blood pressure measurements after taking an extensive walk. But I couldn't find any clear indication as to the best way to proceed.

Regarding you being prescribed with the metoprolol, if your blood pressure is normal range other than when you exercise, wouldn't that drag it down to a too low number? What was your doctor's reasoning for prescribing this particular med. vs. not doing anything. vs. another med?

Thanks!

49er[/quote]

49er-

His reasoning for prescribing the med was to normalize my BP across the board. He knows that my HR during sleep was falling to 33bpm, but I have been put on oxygen since then and, as he said, it has raised my HR to a low of ~57bpm, which is good. Since I never have checked my BP immediately following, or during, exercise, I had no idea that this was going on, and I think most people don't check theirs during/after exercise either. Now I'm worried about exercising. At least it's taken my mind off sleep for now!

M'ohms · Post by **M'ohms** » Sat Feb 21, 2015 10:46 am

Sheffey wrote:
M'ohms wrote:He is starting me on 25 mg Metoprolol Succinate ER.
Did he talk to you about lifestyle changes?

No, he really didn't have much to say about it at all, that's why I thought I would run it past this group.

Morbius · Post by **Morbius** » Sat Feb 21, 2015 10:54 am

M'ohms wrote:...that's why I thought I would run it past this group.

Yeah, like following the above advice and trying beta-blockers.

Maybe you can get your heart to stop altogether.

49er · Post by **49er** » Sat Feb 21, 2015 11:01 am

Morbius wrote:
M'ohms wrote:...that's why I thought I would run it past this group.
Yeah, like following the above advice and trying beta-blockers.

Maybe you can get your heart to stop altogether.

Morbius,

Care to clarify?

Sorry if I am not picking up on something obvious.

49er

49er · Post by **49er** » Sat Feb 21, 2015 11:11 am

M'ohms wrote:

Hi M'ohms,

I suspect I have this based on a few blood pressure measurements after taking an extensive walk. But I couldn't find any clear indication as to the best way to proceed.

Regarding you being prescribed with the metoprolol, if your blood pressure is normal range other than when you exercise, wouldn't that drag it down to a too low number? What was your doctor's reasoning for prescribing this particular med. vs. not doing anything. vs. another med?

Thanks!

49er[/quote]

49er-

His reasoning for prescribing the med was to normalize my BP across the board. He knows that my HR during sleep was falling to 33bpm, but I have been put on oxygen since then and, as he said, it has raised my HR to a low of ~57bpm, which is good. Since I never have checked my BP immediately following, or during, exercise, I had no idea that this was going on, and I think most people don't check theirs during/after exercise either. Now I'm worried about exercising. At least it's taken my mind off sleep for now! [/quote]

Thanks Mohm's. I hope the BB doesn't interfere with your exercise ability. When I was briefly on carvedilol before a 24 hour blood pressure monitor cleared me of high blood pressure (may not be accurate now), it completely trashed it.

M'ohms · Post by **M'ohms** » Sat Feb 21, 2015 11:29 am

49er,

Over what period of time did it take for you to have the symptoms of not feeling like exercising? Do you think the 2week window that the doc is giving me will expose that side effect?

49er · Post by **49er** » Sat Feb 21, 2015 11:47 am

M'ohms wrote:49er,

Over what period of time did it take for you to have the symptoms of not feeling like exercising? Do you think the 2week window that the doc is giving me will expose that side effect?

M'ohms,

For me, it appeared very quickly even when I took half the recommended starting dose. I found that extremely depressing and frustrating. But I am extremely med sensitive so you please don't go by my situation.

I have no idea about your situation. Ask your doc to see what he says.

And some people have had better luck with other BBs when the first one didn't work out. So if god forbid, this one causes problems, you might want to keep that in mind.

M'ohms · Post by **M'ohms** » Sat Feb 21, 2015 11:52 am

Thanks, 49er, and once again, you've been very helpful to me.

Morbius · Post by **Morbius** » Sat Feb 21, 2015 11:59 am

49er wrote:
Morbius wrote:
M'ohms wrote:...that's why I thought I would run it past this group.
Yeah, like following the above advice and trying beta-blockers.

Maybe you can get your heart to stop altogether.
Morbius,

Care to clarify?

Sorry if I am not picking up on something obvious.

49er

Obvious!?

Beta blockers slow heart rate, therefore are contraindicated in bradycardia (besides being obsolete). 33 is a horrible bradycardia (and you have to use 33 because no guarantee O2 therapy will be continuous or even if it is consistently effective and 57 is still bradycardia anyway).

So now I'm thinking there's an underlying conduction defect (or she's a marathoner, which I doubt). In the case of fixed HR, that BP response would be about right:

http://www.ncbi.nlm.nih.gov/pubmed/8149531

But if it were EI-H, then there is probably underlying cardiac disease:

http://content.onlinejacc.org/article.a ... id=1127709

but the guy doesn't seem too excited about that, so he's sure there isn't (but why?) or just doing turbodx.

So the next question would be:

What were all the other monitored parameters doing during this time?

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