Doctors Lounge - Cardiology Answers
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Forum Name: Hypertension
|tsteele937 - Tue Apr 14, 2009 2:39 pm||
I am 43, white male with no history of family heart disease. However, I am overweight and not in the best of shape. I weigh 220 and carry it in my stomach. I am 5'10".
Recently I experienced some tightness in my chest and some pains. I would have bet that it was not a heart attack, but I wasn't willing to completely bet my life, so I went to my doctor and had an EKG. It was normal, but he suggested a followup stress-echo test anyway.
I have borderline high blood pressure, with my readings usually running in the 135/85 range. The day I went to the doctor to get the EKG it was much higher, and after several checks I ended up with (a best of) 140/92. So my doctor prescribed Lisinopril 10mg daily.
I went for the stress echo test on Monday and my BP was 136/86. When I did the treadmill, the doctor seemed concerned that my diastolic blood pressure rose quite a bit. I was roughly in the 200/140 range at one point. He said the systolic should rise when exercising, but he did not have an explanation for why the diastolic would rise so much while exercising.
The ultrasounds and EKG's looked good, it was just the strange blood pressure anomaly that remained unexplained. Is this something that is an obvious diagnosis?
|John Kenyon, CNA - Thu Apr 16, 2009 10:44 pm||
While it is normal for systolic BP to go up quite a bit during vigorous exercise (and desireable up to a point, even), it is less common to see the diastolic rise as yours did. However, given your fitness level and body mass index (BMI) this shouldn't seem as surprising. You fall into the obsese range (BMI of 31.6). With the weight and poor fitness level working against you, it's really not surprising the whole system was working overtime during the stress test, and this is all useful information. It tells you first that you really need to start a supervised exercise and diet program, with exercise starting out very conservative and working up. In fact, if it's within insurance guidelines you'd do best starting with an actual cardiac rehab program if it's feasible. Then you could move over to Phase III or unsupervised (but still guided) program, as well as working on weight loss.
I really think these factors are at the bottom of the problem, and if your doctor feels this is abnormal you may want to monitor your blood pressure once or twice daily as well as during and after exercise, but this does happen with people who are deconditioned.
I hope this is helpful. Good luck to you and please follow up with us as needed.
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