Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Cardiovascular Ultrasound
Published in: Cardiovascular Ultrasound 1/2011

Open Access 01-08-2011 | Review

Stress induced hypertensive response: should it be evaluated more carefully?

Authors: Nagehan Kucukler, Fatih Yalçin, Theodore P Abraham, Mario J Garcia

Published in: Cardiovascular Ultrasound | Issue 1/2011

Login to get access

Abstract

Various diagnostic methods have been used to evaluate hypertensive patients under physical and pharmacological stress. Several studies have shown that exercise hypertension has an independent, adverse impact on outcome; however, other prognostic studies have shown that exercise hypertension is a favorable prognostic indicator and associated with good outcome. Exercise hypertension may be encountered as a warning signal of hypertension at rest and future hypertensive left ventricular hypertrophy. The results of diagnostic stress tests support that hypertensive response to exercise is frequently associated with high rate-pressure product in hypertensives. In addition to the observations on high rate-pressure product and enhanced ventricular contractility in patients with hypertension, evaluation of myocardial contractility by Doppler tissue imaging has shown hyperdynamic myocardial function under pharmacological stress. These recent quantitative data in hypertensives suggest that hyperdynamic myocardial function and high rate-pressure product response to stress may be related to exaggerated hypertension, which may have more importance than that it has been already given in clinical practice.
Appendix
Available only for authorised users
Literature
1.
O'Brien E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G, Mengden T, Myers M, Padfield P, Palatini P, Parati G, Pickering T, Redon J, Staessen J, Stergiou G, Verdecchia P, : European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens. 2003, 21: 821-48. 10.1097/00004872-200305000-00001CrossRefPubMed
2.
Smirk FH: Observations on the mortality of 270 treated and 199 untreated retinal grade I and II hypertensive patients followed in all instances for five years. N Z Med J. 1964, 3: 413-43.
3.
Perloff D, Sokolow M, Cowan RM, Juster RP: Prognostic value of ambulatory blood pressure measurements: further analysis. J Hypertens. 1989, 7: 3-10. 10.1097/00004872-198902001-00002.
4.
Grosse P, Durandet P, Roudaut R, Broustet JP, Dallocchio M: Valeur pronostique de la tension artérielle d'effort chez I' hypertendu. Arch Mal Coeur. 1989, 82: 1339-42.
5.
Lauer MS, Levy D, Anderson KM, Plehn JF: Is there a relationship between exercise systolic blood pressure response and left ventricular mass? The Framingham Heart Study. Ann Intern Med. 1992, 116: 203-10.CrossRefPubMed
6.
Laukkanen JA, Kurl S: Blood pressure responses during exercise testing-is up best for prognosis?. Ann Med. 2011
7.
Gottdiener JS, Brown J, Zoltick J, Fletcher RD: Left ventricular hypertrophy in men with normal blood pressure: relation to exaggerated blood pressure response to exercise. Ann Intern Med. 1990, 112: 161-6.CrossRefPubMed
8.
Fagard R, Staessen J, Thijs L, Amery A: Prognostic significance of exercise versus resting blood pressure in hypertensive men. Hypertension. 1991, 17: 574-8.CrossRefPubMed
9.
Filipovsky J, Ducimetiere P, Safar ME: Prognostic significance of exercise blood pressure and heart rate in middle-aged men. Hypertension. 1992, 20: 333-9.CrossRefPubMed
10.
Mundal R, Kjeldsen SE, Sandvik L, Erikssen G, Thaulow E, Erikssen J: Exercise blood pressure predicts cardiovascular mortality in middle-aged men. Hypertension. 1994, 24: 56-62.CrossRefPubMed
11.
Lauer MS, Pashkow FJ, Harvey SA, Marwick TH, Thomas JD: Angiographic and prognostic implications of an exaggerated exercise systolic blood pressure response and rest systolic blood pressure in adults undergoing evaluation for suspected coronary artery disease. J Am Coll Cardiol. 1995, 26: 1630-6. 10.1016/0735-1097(95)00388-6CrossRefPubMed
12.
Fagard RH, Pardaens K, Staessen JA, Thijs L: Prognostic value of invasive hemodynamic measurements at rest and during exercise in hypertensive men. Hypertension. 1996, 28 (1): 31-6.CrossRefPubMed
13.
Filipovsky J, Ducimetiere P, Safar ME: Prognostic significance of exercise blood pressure and heart rate in middle-aged men. Hypertension. 1992, 20: 333-9.CrossRefPubMed
14.
Mundal R, Kjeldsen SE, Sandvik L, Erikssen G, Thanlow E, Erikssen J: Exercise blood pressure predicts cardiovascular mortality in middle-aged men. Hypertension. 1994, 24: 56-62.CrossRefPubMed
15.
Wothius RA, Froelicher VF, Fischer J, Triebwasser JH: The response of healthy men to treadmill exercise. Circulation. 1977, 55: 153-CrossRef
16.
Singh JP, Larson MG, Manolio TA, O'Donnell CJ, Lauer M, Evans JC, Levy D: Blood Pressure Response During Treadmill Testing as Risk Factor for New-Onset Hypertension: The Framingham Heart Study. Circulation. 1999, 99: 1831-6.CrossRefPubMed
17.
de Souza Nery S, Gomides RS, da Silva GV, de Moraes Forjaz CL, Mion D, Tinucci T: Intra-arterial blood pressure response in hypertensive subjects during low- and high-intensity resistance exercise. Sao Paulo. 2010, 65: 271-7.
18.
Sharman JE, Hare JL, Thomas S, Davies JE, Leano R, Jenkins C, Marwick TH: Association of masked hypertension and left ventricular remodeling with the hypertensive response to exercise. Am J Hypertens. 2011, 24 (8): 898-903. 10.1038/ajh.2011.75CrossRefPubMed
19.
Miyai N, Arita M, Morioka I, Miyashita K, Nishio I, Takeda S: Exercise BP response in subjects with high-normal BP: exaggerated blood pressure response to exercise and risk of future hypertension in subjects with high-normal blood pressure. J Am Coll Cardiol. 2000, 36 (5): 1626-31. 10.1016/S0735-1097(00)00903-7CrossRefPubMed
20.
Mottram PM, Haluska B, Yuda S, Leano R, Marwick TH: Patients with a hypertensive response to exercise have impaired systolic function without diastolic dysfunction or left ventricular hypertrophy. J Am Coll Cardiol. 2004, 43: 848-53. 10.1016/j.jacc.2003.08.057CrossRefPubMed
21.
Takamura T, Onishi K, Sugimoto T, Kurita T, Fujimoto N, Dohi K, Tanigawa T, Isaka N, Nobori T, Ito M: Patients with a hypertensive response to exercise have impaired left ventricular diastolic function. Hypertens Res. 2008, 31 (2): 257-63. 10.1291/hypres.31.257CrossRefPubMed
22.
Ha JW, Oh JK, Pellikka PA, Ommen SR, Stussy VL, Bailey KR, Seward JB, Tajik AJ: Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr. 2005, 18 (1): 63-8. 10.1016/j.echo.2004.08.033CrossRefPubMed
23.
Maltagliati A, Berti M, Muratori M, Tamborini G, Zavalloni D, Berna G, Pepi M: Exercise echocardiography versus exercise electrocardiography in the diagnosis of coronary artery disease in hypertension. Am J Hypertens. 2000, 13: 796-801. 10.1016/S0895-7061(00)00247-8CrossRefPubMed
24.
Fragasso G, Lu C, Dabrowski P, Pagnotta P, Shebian I, Chierchia SL: Comparison of stress rest myocardial perfusion tomography, dipyridamole and dobutamine stress echocardiography for the detection of coronary disease in hypertensive patients with chest pain and positive exercise test. J Am Coll Cardiol. 1999, 34: 441-7. 10.1016/S0735-1097(99)00231-4CrossRefPubMed
25.
Astarita C, Palinkas A, Nicolai E, Maresca FS, Varga A, Picano E: Dipyridamole- atropine stress echocardiography versus exercise SPECT sintigraphy for detection of coronary artery disease in hypertensives with positive exercise test. J Hypertens. 2001, 19: 495-502. 10.1097/00004872-200103000-00018CrossRefPubMed
26.
Elhendy A, Geleijnse ML, van Domburg RT, Bax JJ, Nierop PR, Beerens SA, Valkema R, Krenning EP, Mohsen Ibrahim M, Roelandt JR: Comparison of dobutamine stress Echocardiography and technetium-99 m sestamibi single-photon emission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Eur J Nucl Med. 1998, 25: 69-78.CrossRefPubMed
27.
Shin JH, Shiota T, Kim YJ, Kwan J, Qin JX, Eto Y, Rodriguez LL, Thomas JD: False-positive exercise echocardiograms: impact of sex and blood pressure response. Am Heart J. 2003, 146 (5): 914-9. 10.1016/S0002-8703(03)00410-1CrossRefPubMed
28.
Yalcin F, Kucukler N, Haq N, Abraham TP: Evaluation of Regional Myocardial Dynamics in Left Ventricular Hypertrophy Secondary to Essential Hypertension [abstract]. J Am Coll Cardiol. 2011, 57: 2000- 10.1016/j.jacc.2011.02.015CrossRef
29.
Christiaens L, Duplantier C, Allal J, Donal E, Nanadoumgar H, Barraine R, Coisne D: Normal coronary angiogram and dobutamine-induced left ventricular obstruction during stress echocardiography: a higher hemodynamic responsiveness to dobutamine. Echocardiography. 2001, 18 (4): 285-90. 10.1046/j.1540-8175.2001.00285.xCrossRefPubMed
30.
Yalcin F, Yigit F, Erol T, Baltali M, Korkmaz EM, Müderrisoglu H: Effect of dobutamine stress on basal septal tissue dynamics in hypertensive patients with basal septal hypertrophy. J Hum Hypertens. 2006, 20: 628-30. 10.1038/sj.jhh.1002041CrossRefPubMed
31.
Hinderliter AL, Light KC, Willis PW: Patients with borderline elevated blood pressure have enhanced left ventricular contractility. Am J Hypertens. 1995, 8: 1040-5. 10.1016/0895-7061(95)00256-1CrossRefPubMed
32.
Golbasi Z, Sakalli M, Cicek D, Aydogdu S: Dynamic left ventricular outflow tract obstruction in a patient with pheochromocytoma. Jpn Heart J. 1999, 40: 831-5. 10.1536/jhj.40.831CrossRefPubMed
33.
Come PC, Bulkley BH, Goodman ZD, Hutchins GM, Pitt B, Fortuin NJ: Hypercontractile cardiac states stimulating hypertrophic cardiomyopathy. Circulation. 1977, 55: 901-8.CrossRefPubMed
34.
Slotwiner DJ, Devereux RB, Schwartz JE, Pickering TG, de Simone G, Roman MJ: Relation of age to left ventricular function and systemic hemodynamics in uncomplicated mild hypertension. Hypertension. 2001, 37: 1404-9.CrossRefPubMed
35.
Grosu A, Bombardini T, Senni M, Duino V, Gori M, Picano E: End-systolic pressure/volume relationship during dobutamine stress echo: a prognostically useful non-invasive index of left ventricular contractility. Eur Heart J. 2005, 26 (22): 2404-12. 10.1093/eurheartj/ehi444CrossRefPubMed
36.
Bombardini T, Gemignani V, Bianchini E, Pasanisi E, Pratali L, Pianelli M, Faita F, Giannoni M, Arpesella G, Sicari R, Picano E: Post-exercise contractility, diastolic function, and pressure: operator-independent sensor-based intelligent monitoring for heart failure telemedicine. Cardiovasc Ultrasound. 2009, 7: 21-CrossRefPubMedPubMedCentral
37.
Lee CY, Pelikka PA, Shub C, Sinak LJ, Seward JB: Hypertensive response during dobutamine stress echocardiography. Am J Cardiol. 1997, 80: 970-1. 10.1016/S0002-9149(97)00561-4CrossRefPubMed
38.
Fragasso G, Lu C, Dabrowski P, Pagnotta P, Sheiban I, Chierchia SL: Comparison of stress/rest myocardial perfusion tomography, dipyridamole and dobutamine stress echocardiography for the detection of coronary disease in hypertensive patients with chest pain and positive exercise test. J Am Coll Cardiol. 1999, 34: 441-7. 10.1016/S0735-1097(99)00231-4CrossRefPubMed
39.
Ha JW, Juracan EM, Mahoney DW, Oh JK, Shub C, Seward JB, Pelikka PA: Hypertensive response to exercise: a potential cause for new wall motion abnormality in the absence of coronary artery disease. J Am Coll Cardiol. 2002, 39: 323-7.CrossRefPubMed
40.
Kane GC, Askew JW, Chareonthaitawee P, Miller TD, Gibbons RJ: Hypertensive response with exercise does not increase the prevalence of abnormal Tc-99 m SPECT stress perfusion images. Am Heart J. 2008, 155 (5): 930-7. 10.1016/j.ahj.2007.12.017CrossRefPubMed
41.
Erickssen J, Myhre E: False positive exercise ECG: a misnomer?. Int J Cardiol. 1984, 6: 263-8. 10.1016/0167-5273(84)90365-6CrossRef
42.
Detrano R, Froelicher V: Exercise testing: uses and limitations considering recent studies. Prog Cardiovasc Dis. 1988, 31: 173-204. 10.1016/0033-0620(88)90015-1CrossRefPubMed
43.
Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML: Exercise standards: a statement for healthcare professionals from the American Heart Association writing group. Circulation. 1995, 91: 580-615.CrossRefPubMed
44.
Ellestad MH: Stress Testing: Principles and Practice. 1996, 333-4. Philadelphia, PA: FA Davis Company, 4
45.
Lauer MS, Pashkow FJ, Harvey SA, Marwick TH, Thomas JD: Angiographic and prognostic implications of an exaggerated exercise systolic blood pressure response and rest systolic blood pressure in adults undergoing evaluation for suspected coronary artery disease. J Am Coll Cardiol. 1995, 26: 1630-6. 10.1016/0735-1097(95)00388-6CrossRefPubMed
46.
Barnard RJ, MacAlpin R, Kattus AA, Buckberg GD: Ischemic response to sudden strenuous exercise in healthy men. Circulation. 1973, 48: 936-42.CrossRefPubMed
47.
Farah R, Shurtz-Swirski R, Nicola M: High blood pressure response to stress ergometry could predict future hypertension. Eur J Intern Med. 2009, 20: 366-8. 10.1016/j.ejim.2008.09.016CrossRefPubMed
48.
Rosei EA: Assessment of preclinical target organ damage in hypertension: left ventricular hypertrophy. J Hypertens. 2001, 19: 2288-90. 10.1097/00004872-200112000-00027CrossRefPubMed
49.
Lauer MS, Levy D, Anderson KM, Plehn JF: Is there a relationship between exercise systolic blood pressure response and left ventricular mass: The Framingham Heart study. Ann Intern Med. 1992, 116: 203-10.CrossRefPubMed
50.
Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S: Exercise blood pressure and future cardiovascular death in asymptomatic individuals. Circulation. 2010, 121: 2109-16. 10.1161/CIRCULATIONAHA.109.895292CrossRefPubMedPubMedCentral
51.
Miyai N, Arita M, Morioka I, Takeda S, Miyashita K: Ambulatory blood pressure, sympathetic activity, and left ventricular structure and function in middle-aged normotensive men with exaggerated blood pressure response to exercise. Med Sci Monit. 2005, 11 (10): CR478-84.PubMed
52.
Wilson MF, Sung BH, Pincomb GA, Lovallo WR: Exaggerated pressure response to exercise in men at risk for systemic hypertension. Am J Cardiol. 1990, 66: 731-6. 10.1016/0002-9149(90)91139-WCrossRefPubMed
53.
Kavey RW, Kveselis DA, Gaum WE: Exaggerated blood pressure response to exercise in children with increased low-density lipoprotein cholesterol. Am Heart J. 1997, 133: 162-8. 10.1016/S0002-8703(97)70204-7CrossRefPubMed
54.
Folkow B: Vascular changes in hypertension--review and recent animal studies. Drugs. 1985, 29 (12): 1-8.CrossRefPubMed
55.
De Simone G, Devereux RB, Roman MJ, Schlussel Y, Alderman MH, Laragh JH: Echocardiographic left ventricular mass and electrolyte intake predict arterial hypertension. Ann Int Med. 1991, 114: 202-9.CrossRefPubMed
56.
Yalcin F, Muderrisoglu H, Korkmaz ME, Ozin B, Baltali M, Yigit F: The effect of dobutamine stress on left ventricular outflow tract gradients in hypertensive patients with basal septal hypertrophy. Angiology. 2004, 55: 295-301. 10.1177/000331970405500309CrossRefPubMed
57.
Al-Nasser F, Duncan A, Sharma R, O'Sullivan C, Coats AJ, Anker SD, Henein MY: Beta-blocker therapy for dynamic left-ventricular outflow tract obstruction. Int J Cardiol. 2002, 86: 199-205. 10.1016/S0167-5273(02)00312-1CrossRefPubMed
58.
Kokkinos P, Chrysohoou C, Panagiotakos D, Narayan P, Greenberg M, Singh S: Beta-blockade mitigates exercise blood pressure in hypertensive male patients. J Am Coll Cardiol. 2006, 47 (4): 794-8. 10.1016/j.jacc.2005.09.057CrossRefPubMed
59.
Fortini A, Cappelletti C, Cecchi L, Laureano R: Fosinopril in the treatment of hypertension: effects on 24 h ambulatory blood pressure and on blood pressure response to exercise. J Hum Hypertens. 1994, 8 (6): 469-74.PubMed
60.
Warner JG, Metzger DC, Kitzman DW, Wesley DJ, Little WC: Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise. J Am Coll Cardiol. 1999, 33 (6): 1567-72. 10.1016/S0735-1097(99)00048-0CrossRefPubMed
61.
Franz I-W: Ergometry in Hypertensive Patients: Implications for Diagnosis and Treatment. 1985, New York, Tokyo, Berlin, Heidelberg: Springer-Verlag
Metadata
Title
Stress induced hypertensive response: should it be evaluated more carefully?
Authors
Nagehan Kucukler
Fatih Yalçin
Theodore P Abraham
Mario J Garcia
Publication date
01-08-2011
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2011
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/1476-7120-9-22

Other articles of this Issue 1/2011

Cardiovascular Ultrasound 1/2011 Go to the issue

Research

Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?

Research

Right ventricular dysfunction in patients with Brugada-like electrocardiography: a two dimensional strain imaging study

Case report

Assessment right atrial thrombus by real-time three dimensional transthoracic echocardiography in patient with dilated cardiomyopathy

Research

Relationship between tei index and left ventricular geometric patterns in a hypertensive population: a cross-sectional study

Research

Presumptive myocarditis with ST-Elevation myocardial infarction presentation in young males as a new syndrome. Clinical significance and long term follow up

Case report

Exercise-induced left bundle branch block and subsequent mechanical left ventricular dyssynchrony -resolved with pharmacological therapy

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits