Background Previous studies revealed that an abnormal blood pressure response (ABPR) during exercise was common in young hypertrophic cardiomyopathy (HCM) patients and was associated with a family history of premature sudden cardiac death (SCD). This study was performed prospectively to assess the prognostic significance of blood pressure response during exercise in young patients with HCM. Methods and Results Maximum symptom-limited treadmill exercise testing with continuous blood pressure monitoring was performed in 161 consecutive patients 8 to 40 years old (27±9). A normal blood pressure response, defined as an increase in the systolic pressure of at least 20 mm Hg from rest to peak exercise in the absence of a fall of >20 mm Hg from peak pressure, was seen in 101 (63%). In 60 (37%), the blood pressure response was abnormal. There was no significant difference in patients with normal blood pressure response and ABPR in terms of age, sex, follow-up, or recognized risk factors for SCD. During the follow...

Prospective Prognostic Assessment of Blood Pressure Response During Exercise in Patients With Hypertrophic Cardiomyopathy

Current evidence suggests that alterations in the autonomic function and abnormal vascular control play a significant role either as independent triggers themselves or as modifiers of ischaemia and tolerance to to arrhythmias. A combination of several factors--that is, arrhythmia, hypotension, altered autonomic function including vascular control, and ischaemia are therefore likely to act as triggers for sudden death. The relative contribution of each of these factors needs further detailed study.

https://heart.bmj.com/content/heartjnl/79/6/538.full.pdf

Sudden death in hypertrophic cardiomyopathy: potential importance of altered autonomic control of vasculature

In normal subjects during exercise, there is vasoconstriction of non-exercise resistance vessels and an increase in blood pressure. We have investigated patients with vasovagal syncope with structurally normal hearts and patients with hypertrophic cardiomyopathy compared with normal controls and found a failure of vasoconstriction in both patients with vasovagal syncope and hypertrophic cardiomyopathy compared with normals and this has been associated with exercise hypotension. An association between exercise hypotension and sudden death has previously been reported in hypertrophic cardiomyopathy. We speculate that in patients with vasovagal syncope and structurally and electrically normal hearts, exercise hypotension is well tolerated, but in patients with structurally abnormal hearts, exercise hypotension can have catastrophic consequences.

Exercise vascular responses in health and disease.

Venous control in hypertrophic cardiomyopathy: responses to exercise and lower body negative pressure

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Venous control in hypertrophic cardiomyopathy: responses to exercise and lower body negative pressure