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Blood Pressure, Hypertension, and Exercise

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Pediatric Hypertension

Part of the book series: Clinical Hypertension and Vascular Diseases ((CHVD))

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Abstract

Control of blood pressure during activity is a complex process. In this chapter, the physiologic response to activity in normal children and adolescents is reviewed. The exercise BP response and exercise testing recommendations in selected pediatric subpopulations are described: children with hypertension, children at identified risk for premature atherosclerotic disease, and individuals with relevant congenital heart diagnoses (aortic valve stenosis, coarctation of the aorta, hypertrophic cardiomyopathy). The evidence for exercise as nonpharmacologic treatment of primary hypertension is reviewed. This chapter ends with a description of existing activity recommendations for hypertensive children and adolescents.

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References

  1. Braden DS, Strong WB. Cardiovascular responses to exercise in childhood. Am J Dis Child. 1990;144: 1255–60.

    PubMed  CAS  Google Scholar 

  2. Wanne OPS, Haapoja E. Blood pressure during exercise in healthy children. Eur J Appl Physiol. 1988; 58:62–7.

    Article  CAS  Google Scholar 

  3. Riopel DA, Taylor AB, Hohn AR. Blood pressure, heart rate, pressure-rate product and electrocardiographic changes in healthy children during treadmill exercise. Am J Cardiol. 1979;44:697–704.

    Article  PubMed  CAS  Google Scholar 

  4. Schieken RM, Clarke WR, Lauer RM. The cardiovascular responses to exercise in children across the blood pressure distribution: the Muscatine study. Hypertension. 1983;5:71–8.

    Article  PubMed  CAS  Google Scholar 

  5. Ahmad F, Kavey REW, Kveselis DA, Gaum WE. Responses of non-obese white children to treadmill exercise. J Pediatr. 2001;139:284–90.

    Article  PubMed  CAS  Google Scholar 

  6. Daniels SR, Kimball TR, Khoury P, Witt S, Morrison JA. Correlates of the hemodynamic determinants of blood pressure. Hypertension. 1996;28:37–41.

    Article  PubMed  CAS  Google Scholar 

  7. Pate RR, Matthews C, Alpert BS, Strong WB, DuRant RH. Systolic blood pressure response to exercise in black and white preadolescent and early adolescent boys. Arch Pediatr Adolesc Med. 1994;148:1027–31.

    Article  PubMed  CAS  Google Scholar 

  8. Laird WP, Fixler DE, Huffines FD. Cardiovascular response to isometric exercise in normal adolescents. Circulation. 1979;59:651–4.

    Article  PubMed  CAS  Google Scholar 

  9. Rowland T, Heffernan K, Jae SY, Echols G, Fernhall B. Cardiovascular responses to static exercise in boys: insights from tissue Doppler imaging. Eur J Appl Physiol. 2006;97:637–42.

    Article  PubMed  Google Scholar 

  10. Ferrara LA, Mainenti G, Fasano ML, Maroyya T, Borrelli R, Mancini M. Cardiovascular response to mental stress and to handgrip in children. Jpn Heart J. 1991;32:645–54.

    Article  PubMed  CAS  Google Scholar 

  11. MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR. Arterial blood pressure response to heavy resistance exercise. J Appl Physiol. 1985;58:785–90.

    PubMed  CAS  Google Scholar 

  12. Paridon SM, Alpert BS, Boas SR, Cabrera ME, Caldarera LL, Daniels SR, Kimball TR, Knilans TK, Nixon PA, Rhodes J, Yetman AT. Clinical stress testing in the pediatric age group. A statement from the American Heart Association Council on Cardiovascular Disease in the Young, Committee on Atherosclerosis, Hypertension and Obesity in Youth. Circulation. 2006;113:1905–20.

    Article  PubMed  Google Scholar 

  13. Adams FH, Linde LM, Miyake H. The physical working capacity of normal school children: I. California. Pediatrics. 1961;28:55–64.

    PubMed  CAS  Google Scholar 

  14. Adams FH, Bengtsson E, Bervan H, Wegelium C. The physical working capacity of normal school children: 1I. Swedish city and country. Pediatrics. 1961;30:243.

    Google Scholar 

  15. Godfrey S, Davis CTM, Wozniak E, Bawles CA. Cardiorespiratory response to exercise in normal children. Clin Sci. 1971;40:419–42.

    PubMed  CAS  Google Scholar 

  16. Strong WB, Spencer D, Miller MD, Salehbhai M. The physical working capacity of healthy black children. Am J Dis Child. 1978;132:244.

    PubMed  CAS  Google Scholar 

  17. Thapar MK, Strong WB, Miller MD, Leatherbury L, Salehbhai M. Exercise electro-cardiography of healthy black children. Am J Dis Child. 1978;132:592.

    PubMed  CAS  Google Scholar 

  18. Lock JE, Einzig S, Moller JH. Hemodynamic responses to exercise in normal children. Am J Cardiol. 1978;41:1278.

    Article  PubMed  CAS  Google Scholar 

  19. Cumming GR, Everatt D, Hastmen L. Bruce treadmill test in children: normal values in a clinic population. Am J Cardiol. 1978;40:69–75.

    Article  Google Scholar 

  20. James FW, Kaplan S, Glueck CJ, Tsay J-V, Knight MJS, Sarwar CJ. Responses of normal children and young adults to controlled bicycle exercise. Circulation. 1980;61:902–12.

    Article  PubMed  CAS  Google Scholar 

  21. Alpert BS, Dover EV, Booker DL, Martin AM, Strong WB. Blood pressure response to dynamic exercise in healthy children–black vs white. J Pediatr. 1981;99:556–60.

    Article  PubMed  CAS  Google Scholar 

  22. Alpert BS, Flood NL, Strong WB, Dover EV, DuRant RH, Martin AM, Booker DL. Responses to ergometer exercise in a healthy biracial population of children. J Pediatr. 1982;101:538–45.

    Article  PubMed  CAS  Google Scholar 

  23. Washington RL, van Gundy JC, Cohen C, Sondheimer HM, Wolfe RR. Normal aerobic and anaerobic exercise data for North American school-age children. J Pediatr. 1988;112:223–33.

    Article  PubMed  CAS  Google Scholar 

  24. Maffulli N, Greco R, Greco L, D’Alterio D. Treadmill exercise in Neopolitan children and adolescents. Acta Paediatr. 1994;83:106–12.

    Article  PubMed  CAS  Google Scholar 

  25. Lenk MK, Alehan D, Celiker A, Alpay F, Sarici U. Bruce treadmill test in healthy Turkish children: endurance time, heart rate, blood pressure and electrocardiographic changes. Turk J Pediatr. 1998;40: 167–75.

    PubMed  CAS  Google Scholar 

  26. Becker M, deM C, Barbosa e Silva O, Goncalves IE, Victor EG. Arterial blood pressure in adolescents during exercise stress testing. Arq Bras Cardiol. 2007;88:297–300.

    Article  Google Scholar 

  27. Alpert BS, Flood NL, Balfour IC, Strong WB. Automated blood pressure measurement during ergometer exercise in children. Catheter Cardiovasc Diagn. 1982;8:525–33.

    Article  CAS  Google Scholar 

  28. Knecht SK, Mays WA, Gerdes YM, Claytor RP, Knilans TK. Exercise evaluation of upper- versus lower-extremity blood pressure gradients in pediatric and young adult participants. Pediatr Exerc Sci. 2007;18:344–8.

    Google Scholar 

  29. Rasmussen PH, Staats BA, Driscoll DJ, Beck KC, Bonekat HW, Wilcox WD. Direct and indirect blood pressure during exercise. Chest. 1985;87:743–8.

    Article  PubMed  CAS  Google Scholar 

  30. Dlin R. Blood pressure response to dynamic exercise in healthy and hypertensive youths. Pediatrician. 1986;13:34–43.

    PubMed  CAS  Google Scholar 

  31. Nudel DB, Gootman N, Brunson SC, Stenzler A, Shenker IR, Gauthier BG. Exercise performance of hypertensive adolescents. Pediatrics. 1980;65: 1073–8.

    PubMed  CAS  Google Scholar 

  32. Fixler DE, Laird WP, Browne R, Fitzgerald V, Wilson S, Vance R. Response of hypertensive adolescents to dynamic and isometric exercise stress. Pediatrics. 1979;64:579–83.

    PubMed  CAS  Google Scholar 

  33. Wilson SL, Gaffney A, Laird WP, Fixler DE. Body size, composition and fitness in adolescents with elevated blood pressures. Hypertension. 1985;7:417–22.

    PubMed  CAS  Google Scholar 

  34. Klein AA, McCrory WW, Engle MA, Rosenthal R, Ehlers KH. Sympathetic nervous system and exercise tolerance in normotensive and hypertensive adolescents. J Am Coll Cardiol. 1984;3:381–6.

    Article  PubMed  CAS  Google Scholar 

  35. Kavey REW, Kveselis DA, Atallah N, Smith FC. White coat hypertension in childhood: evidence for end-organ effect. J Pediatr. 2007;150:491–7.

    Article  PubMed  Google Scholar 

  36. Kaplan NM, Gidding SS, Pickering TG, Wright JT. 36th Bethesda conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. Task Force 5: systemic hypertension. JACC 2005;45:1326–33.

    Google Scholar 

  37. American Academy of Pediatrics Council on Sports Medicine and Fitness. Policy statement – athletic participation by children and adolescents who have systemic hypertension. Pediatrics. 2010;125(6): 1287–94.

    Article  Google Scholar 

  38. Kaminer SJ, Hixon RL, Strong WB. Evaluation and recommendations for participation in athletics for children with heart disease. Curr Opin Pediatr. 1995;7:595–600.

    Article  PubMed  CAS  Google Scholar 

  39. Alpert BS. Exercise in hypertensive children and adolescents: any harm done? Pediatr Cardiol. 1999;20:66–9.

    Article  PubMed  CAS  Google Scholar 

  40. Strong WB, Malina RM, Blimkie CJR, Daniels SR, Dishman RK, Gutin B, Hergenroeder AC, Must A, Nixon PA, Pivarnik JM, Rowland T, Trost S, Trudeau F. Evidence based physical activity for school-age youth. J Pediatr. 2005;146:732–7.

    Article  PubMed  Google Scholar 

  41. Dlin RA, Hanne N, Silverberg DS, Bar-Or O. Follow-up of normotensive men with exaggerated blood pressure response to exercise. Am Heart J. 1983;106:316–20.

    Article  PubMed  CAS  Google Scholar 

  42. Manolio TA, Burke GL, Savage PJ, Gardin JM, Oberman A. Exercise blood pressure response and 5-year risk of elevated blood pressure in a cohort of young adults: the CARDIA study. Am J Hypertens. 1994;7:234–41.

    Article  PubMed  CAS  Google Scholar 

  43. Lewis GD, Gona P, Larson MG, Plehn JF, Benjamin EJ, O’Donnell CJ, Levy D, Vasan RS, Wang TJ. Exercise blood pressure and the risk of incident cardiovascular disease (from the Framingham Heart study). Am J Cardiol. 2008;101:1614–20.

    Article  PubMed  Google Scholar 

  44. Thanassoulis G, Lyass A, Benjamin EJ, Larson MG, Vita JA, Levy D, Hamburg NM, Widlansky ME, O’Donnell CJ, Mitchell GF, Vasan RS. Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart study. Circulation. 2012;125:2836–43.

    Article  PubMed  Google Scholar 

  45. Mahoney LT, Schieken RM, Clarke WR, Lauer RM. Left ventricular mass and exercise responses predict future blood pressure: the Muscatine study. Hypertension. 1988;12:206–13.

    Article  PubMed  CAS  Google Scholar 

  46. Molineux D, Steptoe A. Exaggerated blood pressure responses to submaximal exercise in normotensive adolescents with a family history of hypertension. J Hypertens. 1988;6:361–5.

    Article  PubMed  CAS  Google Scholar 

  47. Treiber FA, Strong WB, Arensman FW, Forrest T, Davis H, Musante L. Family history of myocardial infarction and hemodynamic responses to exercise in young black boys. Am J Dis Child. 1991;145: 1029–33.

    PubMed  CAS  Google Scholar 

  48. Treiber FA, Murphy JK, Davis H, Raunikar RA, Pflieger K, Strong WB. Pressor reactivity, ethnicity, and 24-hour ambulatory monitoring in children from hypertensive families. Behav Med. 1994;20:133–42.

    Article  PubMed  CAS  Google Scholar 

  49. Treiber FA, Turner JR, Davis H, Thompson W, Levy M, Strong WB. Young children’s cardiovascular stress responses predict resting cardiovascular functioning 2½ years later. J Cardiovasc Risk. 1996;3:95–100.

    Article  PubMed  CAS  Google Scholar 

  50. de Visser DC, van Hooft IMS, van Doornen LJP, Orlebeke JF, Grobbee DE. Cardiovascular response to physical stress in offspring of hypertensive parents: Dutch Hypertension and Offspring study. J Hum Hypertens. 1996;10:781–8.

    PubMed  Google Scholar 

  51. Kavey REW, 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.

    Article  PubMed  CAS  Google Scholar 

  52. Moller NC, Grontved A, Wedderkopp N, Ried-Larsen M, Kristensen PL, Andersen LB, Froberg K. Cardiovascular disease risk factors and blood pressure response during exercise in healthy children and adolescents: the European Youth Heart study. J Appl Physiol. 2010;109:1125–32.

    Article  PubMed  Google Scholar 

  53. Maron BJ, Humphries JO, Rowe RD, Mellitis EG. Prognosis of surgically corrected coarctation of the aorta: a 20 year postoperative appraisal. Circulation. 1973;47:119–26.

    Article  PubMed  CAS  Google Scholar 

  54. Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC. Coarctation of the aorta: long-term follow-up and prediction of outcome after surgical correction. Circulation. 1989;80:840–5.

    Article  PubMed  CAS  Google Scholar 

  55. Toro-Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpenter B, Moller JH. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002;89:541–7.

    Article  PubMed  Google Scholar 

  56. Markham LW, Knecht SK, Daniels SR, Mays WA, Khoury PR, Knilans TK. Development of exercise-induced arm-leg gradient and abnormal arterial compliance in patients with repaired coarctation of the aorta. Am J Cardiol. 2004;94:1200–2.

    Article  PubMed  Google Scholar 

  57. Freed MD, Rocchini A, Rosenthal A, Nadas AS, Castaneda AR. Exercise-induced hypertension after surgical repair of coarctation of the aorta. Am J Cardiol. 1979;43:253–8.

    Article  PubMed  CAS  Google Scholar 

  58. Sigurdardottir LY, Helgason H. Exercise-induced hypertension after corrective surgery for coarctation of the aorta. Pediatr Cardiol. 1996;17:301–7.

    Article  PubMed  CAS  Google Scholar 

  59. Ruttenberg HD. Pre-and post-operative exercise testing of the child with coarctation of the aorta. Pediatr Cardiol. 1999;20:33–7.

    Article  PubMed  CAS  Google Scholar 

  60. de Caro E, Spadoni I, Crepaz R, Saitta M, Trocchio G, Caleno MG, Pongiglione G. Stenting of aortic coarctation and exercise-induced hypertension in the young. Catheter Cardiovasc Interv. 2010;75:256–61.

    Article  PubMed  Google Scholar 

  61. Sehested J, Baandrup U, Mikkelsen E. Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation. Implications for baroreceptor function. Circulation. 1982;65:1060–6.

    Article  PubMed  CAS  Google Scholar 

  62. Beekman RH, Katz BP, Moorehead-Steffens C, Rocchini AP. Altered baroreceptor function in children with systolic hypertension after coarctation repair. Am J Cardiol. 1983;52:112–7.

    Article  PubMed  CAS  Google Scholar 

  63. Gidding SS, Rocchini AP, Moorehead C, Schork MA, Rosenthal A. Increased forearm vascular reactivity in patients with hypertension after repair of coarctation. Circulation. 1985;71:495–9.

    Article  PubMed  CAS  Google Scholar 

  64. Ross RD, Clapp SK, Gunther S, Paridon SM, Humes RA, Farooki ZQ, Pinsky WW. Augmented norepinephrine and renin output in response to maximal exercise in hypertensive coarctectomy patients. Am Heart J. 1992;123:1293–9.

    Article  PubMed  CAS  Google Scholar 

  65. Kimball TR, Reynolds JM, Mays WA, Khoury P, Claytor RP, Daniels SR. Persistent hyperdynamic cardiovascular state at rest and during exercise in children after successful repair of coarctation of the aorta. J Am Coll Cardiol. 1994;24:194–200.

    Article  PubMed  CAS  Google Scholar 

  66. Ou P, Bonnet D, Auriacombe L, Pedroni E, Balleux F, Sidi D, Mousseaux E. Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J. 2004;25: 1853–9.

    Article  PubMed  Google Scholar 

  67. Ong CM, Canter CE, Gutierrez RF, Sekarski DR, Goldring DR. Increased stiffness and persistent narrowing of the aorta after successful repair of coarctation of the aorta: relationship to left ventricular mass and blood pressure at rest and with exercise. Am Heart J. 1992;123:1594–600.

    Article  PubMed  CAS  Google Scholar 

  68. Swan L, Goyal S, Hsia C, Webb G, Gatzoulis MA. Exercise systolic blood pressures are of questionable value in the assessment of the adult with a previous coarctation repair. Heart. 2003;89:189–92.

    Article  PubMed  CAS  Google Scholar 

  69. Vriend JWJ, de Groot E, Bouma BJ, Hrudova J, Kastelein JJP, Tijssen JGP, Mulder BJM. Carotid intima-media thickness in post-coarctectomy patients with exercise-induced hypertension. Heart. 2005;91:962–3.

    Article  PubMed  CAS  Google Scholar 

  70. Luijendijk P, Bouma BT, Vriend JWJ, Vliegan HW, Groenink M, Mulder BJM. Usefulness of exercise-induced hypertension as predictor of chronic hypertension in adults after operative therapy for aortic isthmic coarctation in childhood. Am J Cardiol. 2011;108:435–9.

    Article  PubMed  Google Scholar 

  71. Kavey RE, Cotton JL, Blackman MS. Atenolol therapy for exercise-induced hypertension after aortic coarctation repair. Am J Cardiol. 1990;66:1233–6.

    Article  PubMed  CAS  Google Scholar 

  72. Richardson JW, Anderson FL, Tsagaris TJ. Rest and exercise hemodynamic studies in patients with isolated aortic valve stenosis. Cardiology. 1979;64:1–11.

    Article  PubMed  CAS  Google Scholar 

  73. Clyne CA, Arrighi JA, Maron BJ, Dilsizian V, Bonow RO, Cannon III RO. Systemic and left ventricular responses to exercise stress in asymptomatic patients with valvular aortic stenosis. Am J Cardiol. 1991;68:1469–76.

    Article  PubMed  CAS  Google Scholar 

  74. Lung B, Baron G, Butchart EG. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24:1231–43.

    Article  Google Scholar 

  75. Otto CM, Burwash IG, Legget ME, Munt BI, Fujioka M, Healy NL, Kraft CD, Miyake-Hull CY, Schwaegler RG. Prospective study of asymptomatic valvular aortic stenosis. Circulation. 1997;95: 2262–70.

    Article  PubMed  CAS  Google Scholar 

  76. Amato MCM, Moffa PJ, Werner KE, Ramires JAF. Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing. Heart. 2001;86:381–6.

    Article  PubMed  CAS  Google Scholar 

  77. Das P, Rimington H, Chambers J. Exercise testing to stratify risk in aortic stenosis. Eur Heart J. 2005;26:1309–13.

    Article  PubMed  Google Scholar 

  78. Peidro R, Brion G, Angelino A. Exercise testing in asymptomatic aortic stenosis. Cardiology. 2007;108: 258–64.

    Article  PubMed  Google Scholar 

  79. Rafique AM, Biner S, Ray I, Forrester JS, Tolstrup K, Siegel RJ. Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis. Am J Cardiol. 2009;104:972–7.

    Article  PubMed  Google Scholar 

  80. Pierard LA, Lancellotti P. Stress testing in valve disease. Heart. 2007;93:766–72.

    Article  PubMed  Google Scholar 

  81. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Jr FDP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2008;118:e523–661.

    Article  PubMed  Google Scholar 

  82. Huggenholz PE, Lees MM, Nadas AS. The scalar electrocardiogram, vectorcardiogram and exercise electrocardiogram in the assessment of congenital aortic stenosis. Circulation. 1962;26:79–91.

    Article  Google Scholar 

  83. Halloran KH. The telemetered exercise electrocardiogram in congenital aortic stenosis. Pediatrics. 1971;47:31–9.

    PubMed  CAS  Google Scholar 

  84. Chandramouli B, Ehmke DA, Lauer RM. Exercise-induced electrocardiographic changes in children with congenital aortic stenosis. J Pediatr. 1975;87:725–30.

    Article  PubMed  CAS  Google Scholar 

  85. Alpert BS, Kartodihardjo W, Harp R, Izukawa T, Strong WB. Exercise blood pressure response – a predictor of severity of aortic stenosis in children. J Pediatr. 1981;98:763–5.

    Article  PubMed  CAS  Google Scholar 

  86. Whitmer JT, James FW, Kaplan S, Schwartz DC, Sandker Knight MJ. Exercise testing in children before and after surgical treatment of aortic stenosis. Circulation. 1981;63:254–63.

    Article  PubMed  CAS  Google Scholar 

  87. James FW, Schwartz DB, Kaplan S, Spilkin SP. Exercise electrocardiogram, blood pressure and working capacity in young patients with valvular or subvalvular aortic stenosis. Am J Cardiol. 1982;50: 769–75.

    Article  PubMed  CAS  Google Scholar 

  88. Alpert BS, Moes DM, Durant RH, Strong WB, Flood NL. Hemodynamic responses to ergometer exercise in children and young adults with left ventricular pressure or volume overload. Am J Cardiol. 1983;52:563–7.

    Article  PubMed  CAS  Google Scholar 

  89. Kveselis DA, Rocchini AP, Rosenthal A, Crowley DC, MacDonald D, Snider AR, Moorehead C. Hemodynamic determinants of exercise-induced ST-segment depression in children with valvar aortic stenosis. Am J Cardiol. 1985;55:1133–9.

    Article  PubMed  CAS  Google Scholar 

  90. Bastianon V, Del Bolgia F, Boscioni M, Gobbi V, Marzano MC, Colloridi V. Altered cardiac repolarization during exercise in congenital aortic stenosis. Pediatr Cardiol. 1993;14:23–7.

    PubMed  CAS  Google Scholar 

  91. Yilmaz G, Ozme S, Ozme, Ozer S, Tokel K, Celiker A. Estimation by exercise testing of children with mild and moderate aortic stenosis. Pediatr Int. 2000;42:48–52.

    Article  PubMed  CAS  Google Scholar 

  92. Khalid O, Luzenberg DM, Sable C, Benavidez O, Geva T, Hann b, Abdulla R. Aortic stenosis: the spectrum of practice. Pediatr Cardiol. 2006;27:661–9.

    Article  PubMed  CAS  Google Scholar 

  93. Graham TP, Driscoll DJ, Gersony WM, Newburger JW, Rocchini A, Towbin JA. 36th Bethesda conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. Task Force 2: congenital heart disease. JACC. 2005;45: 1326–33.

    Google Scholar 

  94. Elliott PM, Poloniecki J, Dickie S, et al. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol. 2000;36:2212–8.

    Article  PubMed  CAS  Google Scholar 

  95. Elliott PM, Gimeno Jr B, Mahon NG, Poloniecki JD, McKenna WJ. Relation between severity of left ventricular hypertrophy and prognosis in patients with hypertrophic cardiomyopathy. Lancet. 2001;357:420–4.

    Article  PubMed  CAS  Google Scholar 

  96. Maron BJ, Roberts WC, Epstein SE. Sudden death in hypertrophic cardiomyopathy: a profile of 78 patients. Circulation. 1982;65:1388–94.

    Article  PubMed  CAS  Google Scholar 

  97. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA. 1996;276:199–204.

    Article  PubMed  CAS  Google Scholar 

  98. Maron BJ, Olivotto I, Spirito P, et al. Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non–referral-based patient population. Circulation. 2000;102:858–64.

    Article  PubMed  CAS  Google Scholar 

  99. Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ. Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med. 2000;342:1778–85.

    Article  PubMed  CAS  Google Scholar 

  100. McKenna WJ, Deanfield J, Faruqui A, England D, Oakley CM, Goodwin JF. Prognosis in hypertrophic cardiomyopathy. Am J Cardiol. 1981;47: 532–8.

    Article  PubMed  CAS  Google Scholar 

  101. Fiddler GI, Tajik AJ, Weidman WH, McGoon DC, Ritter DG, Giuliana ER. Idiopathic hypertrophic subaortic stenosis in the young. Am J Cardiol. 1978;42:793–9.

    Article  PubMed  CAS  Google Scholar 

  102. Maron BJ, Tajik AJ, Ruttenberg HD, Graham TP, Atwood VBE, Lie JT, Roberts WC. Hypertrophic cardiomyopathy in infants: clinical features and natural history. Circulation. 1982;65:7–17.

    Article  PubMed  CAS  Google Scholar 

  103. Frenneaux MP, Counihan PJ, Chikamori T, Caforio ALP, McKenna WJ. Abnormal blood pressure response in hypertrophic cardiomyopathy. Circulation. 1990;82:1995–2002.

    Article  PubMed  CAS  Google Scholar 

  104. Sadoul N, Prasad K, Elliot PM, et al. Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy. Circulation. 1997;96:2987–91.

    Article  PubMed  CAS  Google Scholar 

  105. Olivotto I, Maron BJ, Montereggi A. Prognostic value of systemic blood pressure response during exercise in a community-based population with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1999;33:2044–51.

    Article  PubMed  CAS  Google Scholar 

  106. Maki S, Ikeda H, Muro A, et al. Predictors of sudden cardiac death in hypertrophic cardiomyopathy. Am J Cardiol. 1998;82:774–8.

    Article  PubMed  CAS  Google Scholar 

  107. Lele SS, Thomson HL, Seo H, et al. Exercise capacity in hypertrophic cardiomyopathy: role of stroke volume limitation, heart rate and diastolic filling characteristics. Circulation. 1995;92:2886–94.

    Article  PubMed  CAS  Google Scholar 

  108. Ciampi Q, Betocchi S, Volante A, et al. Haemodynamic determinants of exercise induced hypotension in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002;40:278–84.

    Article  PubMed  Google Scholar 

  109. Yoshida N, Ikeda H, Wada T, et al. Exercise-induced abnormal blood pressure responses are related to subendocardial ischemia in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1998;32:1938–42.

    Article  PubMed  CAS  Google Scholar 

  110. Ciampi Q, Betocchi S, Losi MAL, Ferro A, Cuocolo A, Lombardi R, Villari B, Chiarello M. Abnormal blood pressure response to exercise and oxygen consumption in patients with hypertrophic cardiomyopathy. J Nucl Cardiol. 2007;14:869–75.

    Article  PubMed  Google Scholar 

  111. Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH, Spitito P, Ten Cate FJ, Wigle ED. ACC/ESC clinical expert consensus document on hypertrophic cardiomyopathy: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines (Committee to Develop an Expert Consensus Document on Hypertrophic Cardiomyopathy). J Am Coll Cardiol. 2003;42:1687–713.

    Article  PubMed  Google Scholar 

  112. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg. 2011;142(6):e153–203.

    Article  PubMed  Google Scholar 

  113. Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ. Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients. J Am Coll Cardiol. 2003;42: 873–9.

    Article  PubMed  Google Scholar 

  114. Gimeno JR, Tome-Esteban M, Lofiego C, Hurtado J, Pantazis A, Mist B, Lambiase P, McKenna WJ, Elliott PM. Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy. Eur Heart J. 2009;30:2599–605.

    Article  PubMed  Google Scholar 

  115. Klues HG, Leuner C, Kuhn H. Left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: increase in gradient after exercise. J Am Coll Cardiol. 1992;19:527–33.

    Article  PubMed  CAS  Google Scholar 

  116. Shah JS, Esteban MTT, Thaman R, Sharma R, Mist B, Pantazis A, Ward D, Kohli SK, Demetrescu C, Sevdalis E, Keren A, Pellerin D, McKenna WJ, Elliott PM. Prevalence of exercise-induced left ventricular outflow obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy. Heart. 2008;94:1288–94.

    Article  PubMed  CAS  Google Scholar 

  117. Maron MS, Olivotto I, Betocchi S, Casy SA, Lesser JR, Losi MA, Cecchi F, Maron BJ. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med. 2003;348:295–303.

    Article  PubMed  Google Scholar 

  118. Maron MS, Olivotto I, Zenovich AG, Link MS, Pandian NG, Kuvin JT, Nistri S, Cecchi F, Udelson JE, Maron BJ. Hypertrophic cardiomyopathy is primarily a disease of left ventricular outflow tract obstruction. Circulation. 2006;114:2232–9.

    Article  PubMed  Google Scholar 

  119. Sorajja P, Allison T, Hayes C, Nishimura RA, Lam CSP, Ommen SR. Prognostic utility of metabolic exercise testing in minimally symptomatic patients with obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2012;109:1494–8.

    Article  PubMed  Google Scholar 

  120. Sumitomo N, Ito S, Harada K, Kobayashi H, Okuni M. Treadmill exercise test in children with cardiomyopathy and postmyocarditic hypertrophy. Heart Vessels. 1986;1:47–50.

    Article  Google Scholar 

  121. Dilsizian V, Bonow RO, Epstein SE, Fananapazir L. Myocardial ischemia detected by thallium scintigraphy is frequently related to cardiac arrest and syncope in young patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1993;22:796–804.

    Article  PubMed  CAS  Google Scholar 

  122. Yetman AT, Hamilton RM, Benson LN, McCrindle BW. Long-term outcome and prognostic determinants in children with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1998;32:1943–50.

    Article  PubMed  CAS  Google Scholar 

  123. McMahon CJ, Nagueh SF, Pignatelli RH, Denfield SW, Dreyer WJ, Price JF, Clunie S, Bezold LI, Hays AL, Towbin JA, Eidem BW. Characterization of left ventricular diastolic function by tissue Doppler imaging and clinical status in children with hypertrophic cardiomyopathy. Circulation. 2004;109:1756–62.

    Article  PubMed  Google Scholar 

  124. Maskatia SA, Decker JA, Spinner JA, Kim JJ, Price JF, Jefferies JL, Dreyer WJ, O’Brian Smith E, Rossano JW, Denfield SW. Restrictive physiology is associated with poor outcomes in children with hypertrophic cardiomyopathy. Pediatr Cardiol. 2012;33:141–9.

    Article  PubMed  Google Scholar 

  125. Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. 36th Bethesda conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. JACC 2005;45:1340–5.

    Google Scholar 

  126. Whelton SP, Cjin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized controlled trials. Ann Intern Med. 2002;136(7):493–503.

    Article  PubMed  Google Scholar 

  127. Kotsis V, Papakatsika S, Stabouli S. The role of obesity, salt and exercise in blood pressure in children and adolescents. Expert Rev Cardiovasc Ther. 2011;9(6):753–61.

    Article  PubMed  Google Scholar 

  128. Gidding SS, Barton BA, Dorgan JA, Kimm SYS, Kwiterovich PO, Lasser NL, Robson AM, Stevens VJ, Van Horn L, Simons-Morton DG. Higher self-reported physical activity is associated with lower systolic blood pressure: the Dietary Intervention Study in Childhood (DISC). Pediatrics. 2006;118: 2388–93.

    Article  PubMed  Google Scholar 

  129. Janz KF, Dawson JD, Mahoney LT. Increases in physical fitness during childhood improve cardiovascular health during adolescence: the Muscatine study. Int J Sports Med. 2002;23 suppl 1:S15–21.

    Article  PubMed  Google Scholar 

  130. Carnethon MR, Gulati M, Greenland P. Prevalence and cardiovascular disease correlates of low cardiorespiratory fitness in adolescents and adults. JAMA. 2005;294(23):2981–8.

    Article  PubMed  CAS  Google Scholar 

  131. Lobelo F, Pate RR, Dowda M, Liese AD, Daniels SR. Cardiorespiratory fitness and clustered cardiovascular disease risk in US adolescents. J Adolesc Health. 2010;47:352–9.

    Article  PubMed  Google Scholar 

  132. Boreham C, Twisk J, van Mechelen W, Savage M, Strain J, Cran G. Relationships between the development of biological risk factors for coronary heart disease and lifestyle parameters during adolescence: the Northern Ireland Young Hearts Project. Public Health. 1999;113:7–12.

    PubMed  CAS  Google Scholar 

  133. Fasting MH, Nilsen TIL, Holmen TL, Vik T. Lifestyle related blood pressure and body weight in adolescence: cross sectional data from the Young-HUNT study, Norway. BMC Public Health. 2008;8:111–21.

    Article  PubMed  Google Scholar 

  134. Kelley GA, Kelley KS, Tran ZV. The effects of exercise on resting blood pressure in children and adolescents: a meta-analysis of randomized controlled trials. Prev Cardiol. 2003;6:8–16.

    Article  PubMed  Google Scholar 

  135. Obert P, Mandigouts S, Nottin S, Vinet A, N’Guyen LD, Lecoq AM. Cardiovascular responses to endurance training in children: effect of gender. Eur J Clin Invest. 2003;33:199–208.

    Article  PubMed  CAS  Google Scholar 

  136. Ribeiro MM, Silva AG, Santos NS, Guazzelle I, Matos LNJ, Trombetta IC, Halpern A, Negrao CE, Villares SMF. Diet and exercise training restore blood pressure and vasodilatory responses during physiological maneuvers in obese children. Circulation. 2005;111:1915–23.

    Article  PubMed  Google Scholar 

  137. Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol. 2009;54(25):2396–406.

    Article  PubMed  CAS  Google Scholar 

  138. Magio ABR, Aggoun Y, Martin XE, Marchand LM, Beghetti M, Farpour-Lambert NJ. Long-term follow-up of cardiovascular risk factors after exercise training in obese children. Int J Pediatr Obes. 2011;6:e603–10.

    Article  Google Scholar 

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Authors and Affiliations

  1. Children’s Heart Center, University of Rochester Medical Center, Rochester, NY, USA

    Rae-Ellen W. Kavey M.D., MPH

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  1. Rae-Ellen W. Kavey M.D., MPH
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Correspondence to Rae-Ellen W. Kavey M.D., MPH .

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  1. University of Washington, Division of Pediatrics, Seattle Children's Hospital, Sand Point Way NE. 4800, Seattle, 98105, Washington, USA

    Joseph T. Flynn

  2. Harvard Medical School, Pediatric Nephrology Unit, MassGeneral Hospital for Children at MGH, Fruit St. 55, Boston, 02114, Massachusetts, USA

    Julie R. Ingelfinger

  3. Global Clinical Research, Bristol-Myers Squibb, Route 206 & Provinceline Road, Princeton, 08543, New Jersey, USA

    Ronald J. Portman

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Kavey, RE.W. (2013). Blood Pressure, Hypertension, and Exercise. In: Flynn, J., Ingelfinger, J., Portman, R. (eds) Pediatric Hypertension. Clinical Hypertension and Vascular Diseases. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-490-6_34

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  • DOI: https://doi.org/10.1007/978-1-62703-490-6_34

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