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Pediatric Hypertension pp 741–753Cite as

Exercise Testing in Hypertension and Hypertension in Athletes

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Abstract

Exercise testing is routinely performed to assess functional capacity, identify changes in cardiopulmonary physiology, evaluate symptoms and signs induced by exercise, and to determine the appropriateness of physical activity in children (and adults) with acquired and congenital heart disease. In this chapter, we summarize the basics of exercise testing, discuss what is known regarding the utility of exercise testing in the evaluation of the hypertensive child, and review existing recommendations regarding exercise testing and competitive sports participation in the hypertensive athlete.

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References

  • Aguilar A, Ostrow V, De Luca F, Suarez E (2010) Elevated ambulatory blood pressure in a multi-ethnic population of obese children and adolescents. J Pediatr 156(6):930–935

    Article  PubMed  Google Scholar 

  • Ahern D, Dixon E (2015) Pediatric hypertension: a growing problem. Prim Care 42(1):143–150

    Article  PubMed  Google Scholar 

  • Alpert BS (1999) Exercise in hypertensive children and adolescents: any harm done? Pediatr Cardiol 20:66–69

    Article  CAS  PubMed  Google Scholar 

  • Bhat MA, Neelakandhan KS, Unnikrishnan M, Rathore RS, Mohan Singh MP, Lone GN (2001) Fate of hypertension after repair of coarctation of the aorta in adults. Br J Surg 88(4):536–538

    Article  CAS  PubMed  Google Scholar 

  • Black HR, Sica D, Ferdinand K, White WB (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 6: hypertension: a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 66(21):2393–2397

    Article  PubMed  Google Scholar 

  • Becker Mde MC, Barbosa e Silva O, Goncalves IE, Victor EG (2007) Arterial blood pressure in adolescents during exercise stress testing. Arq Bras Cardiol 88:297–300

    Google Scholar 

  • Braden DS, Strong WB (1990 Nov) Cardiovascular responses to exercise in childhood. Am J Dis Child 144(11):1255–1260

    CAS  PubMed  Google Scholar 

  • Buck JA, Amundsen LR, Nielsen DH (1980) Systolic blood pressure responses during isometric contractions of large and small muscle groups. Med Sci Sports Exerc 12(3):145–147

    Article  CAS  PubMed  Google Scholar 

  • Caselli S, Maron MS, Urbano-Moral JA, Pandian NG, Maron BJ, Pelliccia A (2014) Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. Am J Cardiol 114(9):1383–1389

    Article  PubMed  Google Scholar 

  • Daniels SR, Benuck I, Christakis DA, Dennison BA, Gidding SS, Gillman MW, Gottesman MM, Kwiterovich PO, McBride PE, McCrindle BW, Rocchini AP, Urbina EM, Van Horn LV, Washington RL (2011) Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics 128(Suppl 5):S213–S256

    Google Scholar 

  • de Lima SG, de Albuquerque MF, de Oliveira JR, Ayres CF, da Cunha JE, de Oliveira DF, de Lemos RR, de Souza MB, e Silva OB (2012) Exaggerated blood pressure response during exercise treadmill testing: functional and hemodynamic features, and risk factors. Hypertens Res 35(7):733–738

    Article  PubMed  Google Scholar 

  • de Moraes AC, Lacerda MB, Moreno LA, Horta BL, Carvalho HB (2014) Prevalence of high blood pressure in 122,053 adolescents: a systematic review and meta-regression. Medicine (Baltimore) 93(27):e232

    Article  Google Scholar 

  • de Sousa G, Hussein A, Trowitzsch E, Andler W, Reinehr T (2009) Hemodynamic responses to exercise in obese children and adolescents before and after overweight reduction. Klin Padiatr 221(4):237–240

    Article  PubMed  Google Scholar 

  • Engvall J, Sonnhag C, Nylander E, Stenport G, Karlsson E, Wranne B (1995) Arm-ankle systolic blood pressure difference at rest and after exercise in the assessment of aortic coarctation. Br Heart J 73(3):270–276

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Falkner B, Daniels SR (2004) Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension 44(4):387–388

    Article  CAS  PubMed  Google Scholar 

  • Farpour-Lambert NJ, Aggoun Y, Marchand LM, Martin XE, Herrmann FR, Beghetti M (2009) Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in prepubertal obese children. J Am Coll Cardiol 54(25):2396–2406

    Article  CAS  Google Scholar 

  • Fife-Schaw C, de Lusignan S, Wainwright J, Sprake H, Laver S, Heald V, Orton J, Prescott M, Carr H, O'Neill M (2014) Comparing exercise interventions to increase persistence with physical exercise and sporting activity among people with hypertension or high normal blood pressure: study protocol for a randomised controlled trial. Trials 15:336

    Article  PubMed  PubMed Central  Google Scholar 

  • García-Hermoso A, Saavedra JM, Escalante Y (2013) Effects of exercise on resting blood pressure in obese children: a meta-analysis of randomized controlled trials. Obes Rev 14(11):919–928

    Article  PubMed  Google Scholar 

  • Godfrey S, Davis CTM, Wozniak E, Bawles CA (1971) Cardiorespiratory response to exercise in normal children. Clin Sci 40:419–442

    Article  CAS  PubMed  Google Scholar 

  • Graham TP, Driscoll DJ, Gersony WM, Newburger JW, Rocchini A, Towbin JA (2005) Task force 2: congenital heart disease. J Am Coll Cardiol 45(8):1326–1333

    Article  PubMed  Google Scholar 

  • Gusso S, Hofman P, Lalande S, Cutfield W, Robinson E, Baldi JC (2008) Impaired stroke volume and aerobic capacity in female adolescents with type 1 and type 2 diabetes mellitus. Diabetologia 51(7):1317–1320

    Article  CAS  PubMed  Google Scholar 

  • Hacke C, Weisser B (2015) Effects of parental smoking on exercise systolic blood pressure in adolescents. J Am Heart Assoc 11:4(5)

    Google Scholar 

  • Hager A, Kanz S, Kaemmerer H, Schreiber C, Hess J (2007) Coarctation long-term assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg 134(3):738–745

    Article  PubMed  Google Scholar 

  • Hermansen L, Saltin B (1969) Oxygen uptake during maximal treadmill and bicycle exercise. J Appl Physiol 26(1):31–37

    Article  CAS  PubMed  Google Scholar 

  • Inuzuka R, Diller GP, Borgia F, Benson L, Tay EL, Alonso-Gonzalez R, ..., Gatzoulis MA (2012) Comprehensive use of cardiopulmonary exercise testing identifies adults with congenital heart disease at increased mortality risk in the medium term. Circulation 125(2): 250–259

    Article  PubMed  Google Scholar 

  • Jetté M, Sidney K, Blümchen G (1990) Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 13(8):555–565. Review

    Article  PubMed  Google Scholar 

  • Kahan T, Persson H (2015) The importance of left ventricular geometry in hypertensive heart disease. J Hypertens 33(4):690–692

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  • Karpinos AR, Roumie CL, Nian H, Diamond AB, Rothman RL (2013) High prevalence of hypertension among collegiate football athletes. Circ Cardiovasc Qual Outcomes 6(6):716–723

    Article  PubMed  PubMed Central  Google Scholar 

  • Kavey REW, Kveselis DA, Gaum WE (1997) Exaggerated blood pressure response to exercise in children with increased low-density lipoprotein cholesterol. Am Heart J 133(2):162–168

    Article  CAS  PubMed  Google Scholar 

  • Kelley GA, Kelley KS, Pate RR (2015) Exercise and BMI in overweight and obese children and adolescents: a systematic review and trial sequential meta-analysis. Biomed Res Int 2015:704539

    PubMed  PubMed Central  Google Scholar 

  • Laukkanen JA, Khan H, Kurl S, Willeit P, Karppi J, Ronkainen K, Di Angelantonio E (2014) Left ventricular mass and the risk of sudden cardiac death: a population-based study. J Am Heart Assoc 3(6):e001285

    Article  PubMed  PubMed Central  Google Scholar 

  • Levine BD, Baggish AL, Kovacs RJ, Link MS, Maron MS, Mitchell JH (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 1: Classification of sports: dynamic, static, and impact: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66(21):2350–2355

    Article  PubMed  Google Scholar 

  • Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK (1996) The progression from Hypertension to congestive heart failure. JAMA 275(20):1557–1562

    Article  CAS  Google Scholar 

  • Lima SG, Albuquerque MF, Oliveira JR, Ayres CF, Cunha JE, Oliveira DF, Lemos RR, Souza MB, Barbosa e Silva O (2013) Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension. Braz J Med Biol Res 46(4):368–347

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Longmuir PE, Brothers JA, de Ferranti SD, Hayman LL, Van Hare GF, Matherne GP, Davis CK, Joy EA, BW MC, American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young (2013) Promotion of physical activity for children and adults with congenital heart disease: a scientific statement from the American Heart Association. Circulation 127(21):2147–2159

    Article  PubMed  Google Scholar 

  • Maron BJ, Gohman TE, Aeppli D (1998) Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol 32:1881–1884

    Article  CAS  PubMed  Google Scholar 

  • Maron BJ, Haas TS, Duncanson ER, Garberich RF, Baker AM, Mackey-Bojack S (2016) Comparison of the frequency of sudden cardiovascular deaths in young competitive athletes versus Nonathletes: should we really screen only athletes? Am J Cardiol 117(8):1339–1341

    Article  PubMed  Google Scholar 

  • Matthews CE, Pate RR, Jackson KL, Ward DS, Macera CA, Kohl HW, Blair SN (1998) Exaggerated blood pressure response to dynamic exercise and risk of future hypertension. J Clin Epidemiol 51(1):29–35

    Article  CAS  PubMed  Google Scholar 

  • Madueme PC, Khoury PR, Urbina EM, Kimball TR (2013) Predictors of exaggerated exercise-induced systolic blood pressures in young patients after coarctation repair. Cardiol Young 23(3):416–422

    Article  PubMed  Google Scholar 

  • Markham LW, Knecht SK, Daniels SR, Mays WA, Khoury PR, Knilans TK (2004) Development of exercise induced arm-leg gradient and abnormal arterial compliance in patients with repaired coarctation of the aorta. Am J Cardiol 94:1200–1202

    Article  PubMed  Google Scholar 

  • Mazic S, Suzic Lazic J, Dekleva M, Antic M, Soldatovic I, Djelic M, Nesic D, Acimovic T, Lazic M, Lazovic B, Suzic S (2015) The impact of elevated blood pressure on exercise capacity in elite athletes. Int J Cardiol 180:171–177

    Article  PubMed  Google Scholar 

  • Maziekas MT, LeMura LM, Stoddard NM, Kaercher S, Martucci T (2003) Follow up exercise studies in paediatric obesity: implications for long term effectiveness. Br J Sports Med 37(5):425–429

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mitchell JH, Haskell WL, Raven PB (1994) Classification of sports. J Am Coll Cardiol 24(4):864–866

    Article  CAS  PubMed  Google Scholar 

  • Mitchell JH, Payne FC, Saltin B, Schibye B (1980) The role of muscle mass in the cardiovascular response to static contractions. J Physiol 309:45–54

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mitchell JH, Schibye B, Payne FC 3rd, Saltin B (1981) Response of arterial blood pressure to static exercise in relation to muscle mass, force development, and electromyographic activity. Circ Res 48(6 Pt 2):I70–I75

    CAS  PubMed  Google Scholar 

  • Miyai N, Arita M, Miyashita K, Morioka I, Shiraishi T, Nishio I (2002) Blood pressure response to heart rate during exercise test and risk of future hypertension. Hypertension 39(3):761–766

    Article  CAS  PubMed  Google Scholar 

  • Nadeau KJ, Zeitler PS, Bauer TA, Brown MS, Dorosz JL, Draznin B, Reusch JE, Regensteiner JG (2009) Insulin resistance in adolescents with type 2 diabetes is associated with impaired exercise capacity. J Clin Endocrinol Metab 94(10):3687–3695

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ou P, Bonnet D, Auriacombe L, Pedroni E, Balleux F, Sidi D, Mousseaux E (2004) Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J 25:1853–1859

    Article  PubMed  Google Scholar 

  • Paridon SM, Alpert BS, Boas SR, Cabrera ME, Caldarera LL, Daniels SR, Kimball TR, Knilans TK, Nixon PA, Rhodes J, Yetman AT (2006) 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 113:1905–1920

    Article  PubMed  Google Scholar 

  • Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M et al (1993) Human blood pressure determination by sphygmomanometry. Circulation 88(5):2460–2470

    Article  CAS  PubMed  Google Scholar 

  • Presbitero P, Demarie D, Villani M, Perinetto EA, Riva G, Orzan F, Bobbio M, Morea M, Brusca A (1987) Long term results (15-30 years) of surgical repair of aortic coarctation. Br Heart J 57(5):462–467

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Reinier, K., Nichols, G. A., Huertas-Vazquez, A., Uy-Evanado, A., Teodorescu, C., Stecker, E. C., ..., Chugh, S. S. (2015) Distinctive clinical profile of blacks versus whites presenting with sudden cardiac arrest. Circulation

    Google Scholar 

  • Rice SG (2008) American Academy of Pediatrics Council on sports Medicine and fitness. Medical conditions affecting sports participation. Pediatrics 121(4):841–848

    Article  PubMed  Google Scholar 

  • Schieken RM, Clarke WR, Lauer RM (1983) The cardiovascular responses to exercise in children across the blood pressure distribution: the Muscatine study. Hypertension 5:71–78

    Article  CAS  Google Scholar 

  • Schuster I, Karpoff L, Perez-Martin A, Oudot C, Startun A, Rubini M, Obert P, Vinet A (2009) Cardiac function during exercise in obese prepubertal boys: effect of degree of obesity. Obesity (Silver Spring) 17(10):1878–1883

    Article  Google Scholar 

  • Seals DR, Washburn RA, Hanson PG, Painter PL, Nagle FJ (1983) Increased cardiovascular response to static contraction of larger muscle groups. J Appl Physiol Respir Environ Exerc Physiol 54(2):434–437

    CAS  PubMed  Google Scholar 

  • Shook RP, Lee DC, Sui X, Prasad V, Hooker SP, Church TS, Blair SN (2012) Cardiorespiratory fitness reduces the risk of incident hypertension associated with a parental history of hypertension. Hypertension 59(6):1220–1224

    Article  CAS  PubMed  Google Scholar 

  • Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ (2004) Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 113(3 Pt 1):475–482

    Article  Google Scholar 

  • Taverny G, Mimouni Y, LeDigarcher A, Chevalier P, Thijs L, Wright JM, Gueyffier F (2016) Antihypertensive pharmacotherapy for prevention of sudden cardiac death in hypertensive individuals. Cochrane Database Syst Rev 3:CD011745

    PubMed  Google Scholar 

  • (1997) The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 157(21):2413–2446

    Google Scholar 

  • Treiber FA, Strong WB, Arensman FW, Forrest T, Davis H, Musante L (1991) Family history of myocardial infarction and hemodynamic responses to exercise in young black boys. Am J Dis Child 145(9):1029–1033

    CAS  PubMed  Google Scholar 

  • Washington RL, Bricker JT, Alpert BS, Daniels SR, Deckelbaum RJ, Fisher EA, ..., Marx GR (1994) Guidelines for exercise testing in the pediatric age group. From the committee on atherosclerosis and hypertension in children, Council on cardiovascular disease in the young, the American Heart Association. Circulation 90(4): 2166–2179

    Article  CAS  PubMed  Google Scholar 

  • Yardley JE, MacMillan F, Hay J, Wittmeier K, Wicklow B, AC MI, McGavock J (2015) The blood pressure response to exercise in youth with impaired glucose tolerance and type 2 diabetes. Pediatr Exerc Sci 27(1):120–127

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, University of Maryland School of Medicine, 110 S. Paca Street, 7th floor, Baltimore, 21201, MD, USA

    Carissa M. Baker-Smith & Nicholas Pietris

Authors
  1. Carissa M. Baker-Smith
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  2. Nicholas Pietris
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Corresponding author

Correspondence to Carissa M. Baker-Smith .

Editor information

Editors and Affiliations

  1. University of Washington School of Medicine, Department of Pediatrics and Seattle Children’s Hospital Division of Nephrology, Seattle, WA, USA

    Joseph T. Flynn

  2. Division of Nephrology MassGeneral for Children at Massachusetts General Hospital, Harvard Medical School Department of Pediatrics, Boston, MA, USA

    Julie R. Ingelfinger

  3. St. Luke’s Health System, Children’s Nephrology and Hypertension, Boise, ID, USA

    Karen M. Redwine

Section Editor information

  1. Children's Nephrology and Hypertension, St. Luke's Health Systm, 222 North 2nd St, Suite 215, 83702, Boise, ID, USA

    Karen M. Redwine MD

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Baker-Smith, C.M., Pietris, N. (2018). Exercise Testing in Hypertension and Hypertension in Athletes. In: Flynn, J., Ingelfinger, J., Redwine, K. (eds) Pediatric Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-31107-4_12

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  • DOI: https://doi.org/10.1007/978-3-319-31107-4_12

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  • Print ISBN: 978-3-319-31106-7

  • Online ISBN: 978-3-319-31107-4

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