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High BP on exercise

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Hello im a 23 year old male in reasonably good shape, physically im 6ft4 and about 195lbs, I have a hard physical job and i also cycle about 3 times a week. Anyway i recently purchased a home blood pressure monitor and my blood pressure seems to average about 110/60 at rest which is considered normal. My concern is my blood pressure readings after jogging for about 5 minutes, when i measure it immediately after exercise it can go up to 160/85 (this is taken when standing with arm hanging down). When i take it right after exercise sitting down resting my arm on the table bent at about a 90 degree angle it consistently averages about 160/60. From what i have read the systolic response is perfectly normal but the diastolic reading should stay about the same but mine increases significantly after exercise. On many websites it states that a significant exercise induced diastolic increase is indicative of coronary artery disease, i know im really young but i have a shocking family history of early heart attacks and heart disease on my fathers side. my grandfather died in his early 30s and two uncles died around 40, all had extensive arterial blockages. This has me real worried that i may have clogged arteries. When i visited my doctor recently i had an ecg which was normal and also many blood tests. My total cholesterol was about 150 (the test didnt provide a breakdown of LDL/HDL though) my triglycerides were low, my fasting blood sugar was 77mg/dl, CRP and ESR were both in the normal range, full blood count was normal so were serum chemistry tests. Prior to my blood tests he said he would book me in for a stress test but after all the blood tests he said further testing would be a waste of time. I explained my concern about the post exercise rise in diastolic blood pressure but he shrugged it off. This has me worried sick that im a heart attack waiting to happen despite my apparently good health. Anyway im wondering what the correct technique for measuring blood pressure right after exercise is, should the diastolic change that much based on body and arm position. To be sure the measurements were right i repeated the process multiple times and when measuring standing up with arm hanging down it was consistently around 160/85, and measuring seated it averaged about 160/60. an answer to this would be much appreciated as it has me real stressed out.

Category: Cardiologist

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Category: Cardiologist
 31 Doctors Online

Hello
Thank you for your query at DoctorSpring.com.

Since you can perform heavy work without any distress and considering your young age and absence of any traditional risk factors coronary artery blockages are extremely unlikely to be present. A TMT or stress test would be fruitless.
You are correct that the diastolic bp should fall during exercise which doesn't happen in your case.
It could be called a hypertensive exercise response.

But it doesn't signify that you have coronary blockages. It may mean that your peripheral resistance doesn't decrease after exercise as it should normally. This may indicate that you may be at risk of developing diastolic hypertension which is common in middle aged people. The treatment guidelines for hypertension are based on resting bp and elevated exercise bp doesn't warrant treatment.

So my advice is that despite your family history you need to avoid being anxious about coronary artery disease. Take preventive measures against hypertension. Increase fruits nuts and whole grain intake. Sprouts n green leafy vegetables should help.

Continue exercising and monitor your bp 6 monthly at rest.

Hope this helps, I would be glad to answer any follow-up queries.
Regards
Dr Vivek Mahajan
DM Cardiology


Patient replied :

Hi again thanks for the quick response it helps put my mind somewhat at ease. One more thing i forgot to mention is that i noticed a slight diagonal ear lobe crease in my right ear, from what ive read this seems to be predictive for future cardiovascular problems. This along with an hypertensive response to exercise would indicate im at high risk for the development of hypertension and coronary artery disease later in life. I will follow your suggestions on diet and exercise, i also take fairly high doses of fish oils and vitamin c. with taking these risk factors into consideration how likely is it i will develop blocked arteries in the future? once again thanks for your help.


Hello,

It is just an observation that people with earlobe crease have more incidence of coronary artery disease. It is an observation coming down from old textbooks. But I have not come across a proper longitudinal study wherein people with earlobe crease were compared with normal population.

As of now we shall take it that you maybe at a greater risk of future hypertension and perhaps cad because of your family history. If that leads you to take precautions then I am happy. Vit c isn't beneficial as per evidence available.

Follow the health advice religiously and you may then stop worrying about the future.

Regards
Dr Vivek Mahajan
DM Cardiology


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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