Effects of Antihypertensive Agents on Blood Pressure during Exercise.

Arita, Mikio; Hashizume, Toshinori; Wanaka, Yoshio; Handa, Satoshi; Nakamura, Chigusa; Fujiwara, Setsuko; Nishio, Ichiro

doi:10.1291/hypres.24.671

Cited by 10 publications

(4 citation statements)

References 28 publications

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“…However, this effect was evident only in children taking antihypertensive medications. This is not a surprise since BP medications maintain their antihypertensive effect during exercise [11,12]. Interestingly, children with CKD who were not taking antihypertensives had a similar to controls response to exercise, suggesting a physiological response in this group of patients.…”

Section: Discussionmentioning

confidence: 91%

Blood pressure and total peripheral resistance in children with chronic kidney disease

et al. 2005

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We performed a study to assess cardiac output (CO) and total peripheral resistance (TPR) at rest and during peak exercise with the goal to better define the role of these parameters in the development of hypertension in children with chronic kidney disease (CKD) stage 2-4. Fifty-two pediatric patients with CKD (mean age 12.7+/-3.7 years) and 28 healthy individuals of comparable age and sex participated in the study. At rest, children with CKD had a significantly higher systolic and diastolic blood pressure (BP) and calculated mean arterial pressure (MAP) than healthy controls. Total peripheral resistance was significantly higher in children with CKD than in controls (1627.7+/-534.6 vs 1354.6+/-338.9 dynexsxcm(-5), p =0.02). There was no significant difference in heart rate or CO between the two groups. Children taking antihypertensive medications had lower TPR than children without BP medications (1514.6+/-439.6 vs 1788.2+/-505.4 dynexsxcm(-5), respectively, p =0.06). At peak exercise, children with CKD had a significant increase in MAP, heart rate and CO and had a significant decrease in TPR (difference between rest and peak exercise: -782.4+/-375.9 dynexsxcm(-5), p <0.001). Children taking BP medications had blunted MAP and CO responses when compared to controls (Delta CO: 6.2+/-2.8 l/min vs 9.8+/-4.5 l/min, respectively, p =0.01; MAP: 13.9+/-10.2 mmHg vs 21.5+/-11.7 mmHg, respectively, p =0.01). Children without BP medications had a similar to controls response to exercise in respect to CO, MAP and TPR. We conclude that increased TPR is a major contributor to elevated blood pressure in children with CKD and suggest that BP medications decreasing vascular resistance should be used as a first line of antihypertensive therapy in these patients.

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Section: Discussionmentioning

confidence: 91%

Blood pressure and total peripheral resistance in children with chronic kidney disease

et al. 2005

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“…Participants were asked to take their anti-hypertensive medication as normal on study days. Second, the treated-controlled patients began the study already treated for their hypertension and took a variety of different classes of medication, which may have had different effects on exercise BP 38 . Future studies should assess exercise BPs and metaboreflex sensitivity in treatment-naive hypertensives before and following effective anti-hypertensive treatment, assessing the effect of different types of anti-hypertensive medications.…”

Section: Study Limitationsmentioning

confidence: 99%

Antihypertensive Treatment Fails to Control Blood Pressure During Exercise

et al. 2018

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An exaggerated blood pressure (BP) response to maximal exercise is an independent risk factor for cardiovascular events and mortality. It is unclear whether treating BP to guideline recommended levels could normalize the rise in BP during exercise, which is mediated by the metaboreflex. We aimed to assess the BP response to incremental exercise testing and metaboreflex activation in treated-controlled hypertension (n=16), treated-uncontrolled hypertension (n=16), and untreated hypertension (n=11) and 16 control participants with normal BP (n=16). All groups were matched for age and body mass index. BP was measured during an incremental Vo peak test on a cycle ergometer and during metaboreflex isolation using postexercise ischemia. Data were analyzed using 2-way ANOVA with Tukey test for multiple comparisons. Aerobic fitness was similar among groups (=0.97). The rise in absolute systolic BP from baseline at peak exercise was similar in controlled, uncontrolled, and untreated hypertension but greater compared with normotensive controls (Δ71±3, 81±7, 79±8.5 versus 47±5 mm Hg; =0.0001). Metaboreflex sensitivity was also similar in controlled, uncontrolled, and untreated hypertension but augmented compared with normotensive controls (Δsystolic BP: 21±2, 28±2, 25±3 versus 12±2 mm Hg;<0.0001). An amplified pressor response to exercise occurred in patients taking antihypertensive medication, despite having controlled BP at rest and was potentially caused (in part) by enhanced metaboreflex sensitivity. Poor BP control during exercise, partially mediated by the metaboreflex, may contribute to the heightened risk of an adverse cardiovascular event even in treated-controlled patients.

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“…Arterial SBP normally increases during exercise in both patients with hypertension and subjects without hypertension (6,7). The increase in arterial SBP during exercise is frequently exaggerated, especially in subjects over 60 years and patients with hypertension (8,9).…”

Section: Introductionmentioning

confidence: 99%

Patients with a Hypertensive Response to Exercise Have Impaired Left Ventricular Diastolic Function

et al. 2008

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An exaggerated increase in systolic blood pressure prolongs myocardial relaxation and increases left ventricular (LV) chamber stiffness, resulting in an increase in LV filling pressure. We hypothesize that patients with a marked hypertensive response to exercise (HRE) have LV diastolic dysfunction leading to exercise intolerance, even in the absence of resting hypertension. We recruited 129 subjects (age 63 ± 9 years, 64% male) with a preserved ejection fraction and a negative stress test. HRE was evaluated at the end of a 6-min exercise test using the modified Bruce protocol. Patients were categorized into three groups: a group without HRE and without resting hypertension (control group; n =30), a group with HRE but without resting hypertension (HRE group; n =25), and a group with both HRE and resting hypertension (HTN group; n =74). Conventional Doppler and tissue Doppler imaging were performed at rest. After 6-min exercise tests, systolic blood pressure increased in the HRE and HTN groups, compared with the control group (226 ± 17 mmHg, 226 ± 17 mmHg, and 180 ± 15 mmHg, respectively, p <0.001). There were no significant differences in LV ejection fraction, LV end-diastolic diameter, and early mitral inflow velocity among the three groups.However, early diastolic mitral annular velocity (E′) was significantly lower and the ratio of early diastolic mitral inflow velocity (E) to E′ (E/E′) was significantly higher in patients of the HRE and HTN groups compared to controls (E′: 5.9 ± 1.6 cm/s, 5.9 ± 1.7 cm/s, 8.0 ± 1.9 cm/s, respectively, p <0.05). In conclusion, irrespective of the presence of resting hypertension, patients with hypertensive response to exercise had

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Effects of Antihypertensive Agents on Blood Pressure during Exercise.

Cited by 10 publications

References 28 publications

Blood pressure and total peripheral resistance in children with chronic kidney disease

Blood pressure and total peripheral resistance in children with chronic kidney disease

Antihypertensive Treatment Fails to Control Blood Pressure During Exercise

Patients with a Hypertensive Response to Exercise Have Impaired Left Ventricular Diastolic Function

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