0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Clinical Significance of Early vs Late Hypotensive Blood Pressure Response to Treadmill Exercise

Gordon Watson, MD; Eileen Mechling, RN; Gordon A. Ewy, MD
Arch Intern Med. 1992;152(5):1005-1008. doi:10.1001/archinte.1992.00400170089017.
Text Size: A A A
Published online

Background.—  It is generally believed that exerciseinduced hypotension is the result of severe left-main or triple-vessel disease. Since this is not invariably so, and since most studies were performed in male populations, this study was done to determine the frequency of, and the significance of, exercise-induced hypotension in a more general population.

Methods.—  The treadmill exercise tests of 4850 consecutive patients performed at a university medical center over a period of 7.5 years were reviewed. To identify patients for further analysis, a hypotensive blood pressure response was initially defined (1) as a progressive fall in systolic blood pressure, (2) as a failure of the systolic blood pressure to rise more than 5 mm Hg during exercise, or (3) as an initial rise followed by a fall below the resting standing systolic blood pressure.

Results.—  The incidence of exercise-induced hypotension so defined was less than 2% Exercise-induced hypotension occurred in two patterns. An early hypotension response was defined as a fall in systolic blood pressure of more than 10 mm Hg, associated with symptoms or ST-segment depression, during the first 5 minutes of exercise or as a progressive fall in systolic blood pressure of at least 20 mm Hg. The majority of patients (nine of 10) with an early hypotensive response had severe coronary artery disease. The late hypotension pattern was characterized by an initial rise, followed by a fall in the systolic blood pressure with continued exercise. Only half of the patients with this pattern had significant coronary artery disease, and half of the patients had other causes for exercise-induced hypotension. A late hypotensive response was six times more frequent than an early hypotensive response.

Conclusions.—  This study identified two patterns of exercise-induced hypotension. Early, almost always due to severe coronary artery disease, and late, six times more common than early in which only half were due to coronary artery disease. Causes of a late hypotensive response to exercise that were not due to severe coronary artery disease included valvular heart disease, orthostatic hypotension, cardiomyopathy, idiopathic causes, and drugs. Drugs that contributed to a late exercise-induced hypotension response were diuretics, vasodilators, and negative inotropic agents.(Arch Intern Med. 1992;152:1005-1008)

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 4

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();