(28-01-06) High blood pressure may protect against ischemia during exercise

NEW YORK (Reuters Health) - Having a high diastolic blood pressure during exercise appears to have a protective effect against exercise-induced myocardial ischemia, according to a report in the American Heart Journal for October. Further studies, however, are needed to clarify the mechanisms involved.

Most coronary perfusion to the left ventricle occurs during diastole because the vessels are compressed during systole. Therefore, a high diastolic blood pressure during exercise would be hypothesized to have a protective effect on exercise-induced ischemia. Conversely, a high systolic pressure would be expected to exacerbate ischemia.
To investigate these effects, Dr. Hiroyuki Yamagishi, from Osaka City University Graduate School of Medicine in Japan, and colleagues analyzed data from 469 patients with suspected CAD who underwent exercise myocardial SPECT and coronary angiography. A diastolic blood pressure of at least 90 mmHg at peak exercise was considered high.
Roughly half of the patients had normal diastolic blood pressures during exercise and half had high pressures. No significant differences in number of diseased vessels, atherosclerosis severity, as determined by the Gensini score, or medications were noted between the groups.
Patients with high diastolic blood pressure during exercise had a higher pressure-rate product than their peers with normal pressure, suggesting that ischemia was attenuated in the former group. Moreover, the reversibility score on SPECT was significantly smaller in patients with a high diastolic blood pressure during exercise.
Although medication use was similar in patients with normal or high diastolic pressure, "prospective investigation of the degree of exercise-induced ischemia in untreated patients is needed" to confirm the current findings, the authors conclude.

Source : Am Heart J 2005;150:790-795.

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