High Blood Pressure + Low Heart Rate (Hypertensive Reaction to Exercise)

[Captain_Doughnutman]

Not seeking specific medical advice, just general theories, etc.

Quick backstory:
After I got hit by a car a couple of years ago, family doc took a closer look at my overall health. Was running a LCHF diet for a few years which really elevated my cholesterol. That coupled with a history of heart issues on my father’s side sent doc into a tizzy. Now I’m doing all these heart related tests.

Few months ago did an EKG treadmill test.
Test was stopped due to very high blood pressure, but low HR.

Just did a nuclear imaging treadmill test — same result. Test was aborted on these stats: time 10min; HR 110; BP 250/110.

Apparently a BP that high is a 5-alarm emergency. Yet I have never suffered from nor felt any of the related symptoms, either on or off the bike. I also have a low resting BP.

I also recovered super fast, within minutes, to my resting HR and resting BP. The doc was a bit mystified.

Any thoughts on what’s going on??

[handynzl]

I can’t say what is going on, but I was exactly the same on a treadmill test. The doctors were saying “how are you not dead on the floor?”

Genetics has meant that even when in my early 20’s and racing elite division XC my blood pressure was 190/140 or there abouts…even though I was training six days a week and all off HR monitor (no power meters back then). Resting HR was in the low to mid 40’s, max was around 210-ish at the time.

Fast forward 20ish years, and I’m on BP pills (10mg a day) and that keeps me at 120/80 or 120/70 or thereabouts. Max HR at 45 is 182, resting is 53. And also due to genes, I have diabetes as well (try taking on glucose for endurance training when you’re not supposed to have any sugars!), the docs monitor me every six months or less, including cholesterol levels, which when you’re diabetic the green zone is made smaller, so I always fail that one (not enough “good” cholesterol).

Docs have a chart that you must fit in, with a very predetermined delineation of good and bad. Endurance athletes are generally outside of that bell curve.

If anything, they’ll put you on some BP pills, and you can keep riding. Have a CAT scan done so they can see if there is any plaque or crap in and around your heart…you’re already ahead of the curve of people sitting on the couch and then being told to exercise, never doing it, and then keeling over. At least you will train, and you have the tech tools to monitor already strapped to the handlebars.

Fun times

[Captain_Doughnutman]

The doctors were saying “how are you not dead on the floor?”

Ha! Yeah, as I was leaving the nurse gave me a look like “Weirdo.”
And I’ve now had ALL the heart tests. Waiting for the results…

Some prelim reading suggests that it could be Exercise Hypertension:

…in some individuals, the response to exercise is exaggerated. Instead of reaching a systolic (upper number) blood pressure of around 200 mmHg at maximal exercise, they spike at 250 mmHg or higher [I was 250/110] …the endothelial cells failed to dilate enough to handle the extra blood flow. Impaired endothelial function is also associated with aging, menopause, high cholesterol, smoking and diabetes…

I don’t have high cholesterol or diabetes, don’t smoke, aren’t in menopause, and refuse to age.
So what is it?!

Also:

There was no correlation between the stiffness of blood vessel walls or resting blood pressure with increased blood pressure during exercise.

Which is why I’m normal at rest and out of whack at play.

Great.
So now I’ve got exercised induced bronchospasm and exercise hypertension.
I think it’s safe to say that exercise is NOT making me healthier!

Ah, well. Maybe muh heart will go boom during my next VO2 sesh. At least I’ll go out with a bang!

If I’m still around in 2 weeks I’ll update.
(and if you see a batch of bike stuff for sale on craigslist in 2.1 weeks…you’ll know my widowed wife is taking a serious vaycay! ha!)

[Captain_Doughnutman]

Impaired endothelial function

Yup, replying to my own post…

Endothelial dysfunction…is also a reversible disorder.

Applicable Micronutrients & Dietary Factors:
Magnesium
Vitamin C
Coenzyme Q10
Flavonoids
Lipoic acid
Resveratrol
Isoflavones
Nitric Oxide

(Side note: BP started to spike at 60% HRmax which is upper Z1/lower Z2…kinda scary…)

[Captain_Doughnutman]

Just spent the evening reading about exercise hypertension (aka hypertensive response to exercise (HRE); aka emerg level high blood pressure), endothelial cell health, and the sympathetic nervous system, among other weird body stuff.

Came across an “old” study (2011; https://bjsm.bmj.com/content/45/4/378.2) which examined exercise hypertension in endurance athletes.
(Hypertensive response to exercise was defined as systolic blood pressure (SBP) ≥220 mm Hg or diastolic blood pressure (DBP) > 100 mm Hg. I rolled in @250/110.)

Assessed 38 (British) provincial and national athletes without previous diagnosis of systemic hypertension or other cardiovascular disease, training at least 10 h/week. Found 37% to have hypertensive response to exercise.

Kinda scary that it’s such a high number – and to have no idea it’s happening.
Wonder if the pros get tested?

Also read this, http://athleticheartsf.com/qa-about-high-blood-pressure-during-exercise/, which provides such gems as:
“What are the short-term effects of HRE? For the most part, if everything else seems OK, the subject feels fine, and there are no abnormalities on testing, most experts agree that having HRE is not by itself a cause for concern during exercise, so athletes who demonstrate HRE (however defined) should not be alarmed on that basis.”

No one really knows why it occurs in otherwise healthy/athletic subjects, or even what it means (e.g. indicator of a future heart explosion). As above, endothelial cell (mechanical) and sympathetic nervous system (electrical, chemical) health play a part.

More beet juice, baby!!! And arugula with everything!!!
( pretend it’s a beet! )

[GeorgeAnderson]

More Kale, Kale, Kale to help those Endothelium cells.

[Captain_Doughnutman]

More

Gotta use pics! I rarely understand anything without pics!

[Captain_Doughnutman]

Hello internet, just me again…

In the past 48 hours I’ve read almost every study and publication on exercise induced hypertension/hypertensive reaction to exercise and the over-arching conclusion seems to be this:

The condition is present in ~40% of endurance athletes but both cause(s) and effect(s) are unknown.

It still scares the Spankx off me though. Having my brain explode on a sweaty bike trainer in a sh!tty paincave while listening to bad 80’s hair metal is a pretty stupid First World way to shuffle off. I’m sure my wife would be kinda pissed, too, especially if I hadn’t emptied the dishwasher yet.

That said, I have not read of any reported deaths or major malfunctions (stroke, heart attack, etc) in athletes with HRE.

So…VO2 intervals here I come…?

[cyclhist]

It still scares the Spankx off me though. Having my brain explode on a sweaty bike trainer in a sh!tty paincave while listening to bad 80’s hair metal is a pretty stupid First World way to shuffle off. I’m sure my wife would be kinda pissed, too, especially if I hadn’t emptied the dishwasher yet.

So go out in style and change your bloody playlist already! Oh, and empty the dishwasher before your workouts -> problem solved.

[Captain_Doughnutman]

So go out in style

That would require a rad freeride DH MTB…not some spindley locked in the basement road bike.

Oh, Canada!!

[JoeX]

So…VO2 intervals here I come…?

What has your medical doctor said?

Personally, I wouldn’t be eyeing up Ace of Spades, Motörhead right now…

[Captain_Doughnutman]

Results in 2 weeks, follow-up appt in 3 weeks.

As a human, I already know what the answer is but through the lens of an athlete, if I stop cold for 3 weeks I can kiss the last 6 months of training and my A race good-bye. As well, my doc is kinda old school so I can foresee a load of meds coming my way.

Thing is, I was functioning fine before my tests; now I’m just psyching myself out even though nothing has changed.

From all my recent readings, not one paper has addressed or concluded if the effects of endurance athlete HRE are the same as chronic high blood pressure (e.g. stroke). The way I look at it, if the medical establishment doesn’t really have an idea or consensus of who/what/where/why/how, then how can I make any decision other than to carry on as usual?

Maybe I’ll dial it down this weekend and only do 100x110%s instead of 120%s.

[JoeX]

Thing is, I was functioning fine before my tests;

…Hypertension has a scary nickname for a reason.

I doubt he’d have said “stop all exercise” but more likely keep your HR down. Aerobic and sub threshold sessions are probably beneficial…

I wouldn’t second guess my doctor based on Internet opinions.

[Captain_Doughnutman]

Hypertension has a scary nickname for a reason.

Tricky, because it’s not hypertension per se, it’s a hypertensive reaction. Kind of like a sneeze can be the result of having a common cold or allergies – two different underlaying causes. True hypertension is long-term and chronic vs HRE which is acute and short lived (e.g. my BP returned to normal in a matter of minutes).

As well, from examining more closely, my type of HRE could be classified as hypertensive urgency: blood pressure is very high (e.g., ≥180/≥110 mmHg) with minimal or no symptoms, and no signs or symptoms indicating acute organ damage (vs hypertensive emergency: severe blood pressure is accompanied by evidence of progressive organ or system damage); I displayed zero symptoms (even though most/all damage is unannounced (aka silent) ).

Again, in all the clinical literature I’ve been reading, there’s nothing noting the effects of HRE. However, in the studies done of top level athletes, an assumption could be made that the negative effects HRE may not be as severe as those of true HBP simply because those same athletes would have been inflicting their bodies to said condition for years in order to reach high levels of performance.

Or perhaps it’s the endurance training which caused the HRE in the first place.

Or perhaps it’s the endurance training which reduces/eliminates the effects of HRE.

Speculation really, as there is no scientific data published as of yet.

keep your HR down

That’s the thing with HRE, there is a substantial divergence between HR and BP.
During the test my HR was low @110 (e.g. Z2) yet my BP was astronomical 250/110.

Maybe I’ll go garden…

[Captain_Doughnutman]

UPDATE:

Went to my GP today for the test results…all is well from the nuclear imaging test but perhaps showed an irregularity from the ECG test. Weird. He’s consulting a heart doc for me.

In the meantime he’s prescribed a statin and (cue death knell) a beta-blocker.

He also recommended I don’t attempt any PR’s before the follow-up…in 3 weeks.

Not sure what to think. I have no interest in riding my bike at a “moderate” pace, so if I can’t train for 3 week and have to be on BB’s…I’ll call it a career. That’ll kill me harder than any heart attack.

[JoeX]

Not sure what to think.

It’s a downer, but use it to alter your persepective. “Moderate” training is where 90% of the benefits are, where the cake is baked. Anaerobic/VO2 intervals are the icing on the cake…but you’ve got to have the cake to put it on.

I trained on statins for three months last year and noticed no change difference to normal training, ate more fish and lost some bodyfat.

[Captain_Doughnutman]

The statins aren’t the concern – it’s the beta blockers.

They work on the heart, effectively slowing it down and not letting your heart beat rise. Trying to do any type of intensity just isn’t possible. Riding around in lower Z2 doesn’t win races.

From one source:

Instead of using a heart rate monitor, try a simple rating of perceived exertion. On a scale of 1 to 10, aim to exercise at 3 to 5.

Sufferfest describes this zone as “Not too easy, not too hard”. I just call it “Not.”

getting old sucks sometimes

Getting shitty genes sucks all the time.

[bbarrera]

Riding around in lower Z2 doesn’t win races.

But training in z2 can… just ask the Polarized crowd

Didn’t see this thread until just now, getting old sucks sometimes hang in there and stay focused. You’ve built a huge base, a wee break in the trainer action (if forced on you) may actually work some magic

[JoeX]

+1. Training in aerobic zones does win races. Might not be fun, but who said winning was easy?

[aaikins]

Curious why your doc went with a beta blocker. Lots of papers and guidelines out there recommend ACE inhibitors or ARBs for hypertension in athletes. They are not supposed to affect exercise capacity.