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Forum Name: Hypertension

Question: Hypertensive response on stress test


 Stewart - Fri Feb 29, 2008 6:35 pm

I’m male, 62, 5’6”, 135 lb., strong family history of heart disease, never smoked, lifelong physically active, healthy diet. I have never had any heart disease symptoms, but a screening stress test in Jan. 2007 showed 3.7 mm ST depression. A coronary CT scan was also positive, so I underwent angiography. There was 90% blockage mid RCA; a stent was placed. Severe stenosis also found at several points in circumflex, to be managed medically. I’m taking daily: HCTZ 12.5 mg, lisinopril 10 mg, Zetia 10 mg, Lipitor 40 mg, aspirin 81 mg. With these meds, BP at rest is consistently normal, last test showed LDL-C 59, HDL-C 69, TG 60. Unmedicated (and with poor diet), my SBP was typically 130-140, cholesterol as high as 315.

Last December, I took a routine physical that included a stress test. Though EKG remained normal and I felt fine, at 13 minutes the tech said that she would stop the test because my BP was 258/78. Like an idiot, I said that my HR (158) had leveled off and perhaps I could finish the stage. 30 seconds later, BP was 271/76 (HR 159) and the test was halted. Luckily, I did not have a stroke.

Six weeks later, I took a stress echo, both as follow-up on CAD and to check for a hypertensive response. At 16 minutes, my HR of 166 had not changed for 60 seconds, and the test was getting to be not fun, so I asked to stop. Surprisingly, maximum SBP was only 176 (no change in meds). EKG and echo were normal, and I felt no pain. I would greatly appreciate it if you could please answer a few questions: Should my exercise BP be investigated further? Would running until exhausted have made the test more sensitive? Would there have been a significant risk? On a stress echo a year ago (one month after stent), max HR was 176. Should I be concerned that my max HR has apparently fallen 10 BPM in just one year?
 Dr. A. Madia - Tue Mar 11, 2008 11:16 am

User avatar Hi Stewart,

First let me congratulate you, having a strong family history, you were detected for CAD and successfully treated with PTCA-Stent well before you got an MI.

Your post PTCA follow up also seems very good. You are on a good set of medications, your lipids are very much at the desired level.

No, you should not worry that your exercise heart rate has fallen by 10 in a year. This actually indicates better exercise tolerance or conditioning.

You definitely have a hypertensive response to stress, though your BP at rest could be normal. This means that BP would be going beyond acceptable levels while you are exerting day to day without BP monitoring. This definitely calls for some twaeking of your BP meds. Betablocker is a good option if your cardiologist agrees.

I hope this is useful to you, bye,


Apurva.

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