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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Physical exercise results in increased systolic blood pressure &#40;SBP&#41; due to an increase in cardiac output in response to increased oxygen demand by the musculoskeletal system&#46; However&#44; some individuals have an excessive increase in SBP during exercise&#46; This phenomenon is known as exaggerated hypertensive response to exercise &#40;EHRE&#41;&#46; Although there is no consensus on the exact SBP value that defines an EHRE&#44; the first studies defined EHRE as a difference between the SBP peak during the stress test and baseline SBP of at least 60<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in men and 50<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in women&#46; Alternatively&#44; an EHRE is defined as an SBP greater than the 90th percentile &#40;approximately 210<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in men and &#62;190<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in women&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#8211;3</span></a> The diagnostic and prognostic implication of EHRE is controversial&#46; A number of experts have considered that the parameter has no clinical relevance while for others it is a marker of cardiovascular morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Numerous studies have shown an inverse association between the level of physical activity and the incidence of cardiovascular disease &#40;CVD&#41;&#44; such that inactivity and reduced aerobic capacity are powerful predictors of cardiovascular events and all-cause mortality&#44; both in healthy individuals and in those with established CVD&#44; including patients with arterial hypertension &#40;AHT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> For this reason&#44; the challenge of Western societies is to promote physical exercise&#59; however&#44; for certain individuals&#44; exercise can entail an EHRE of undetermined prognostic value&#46; The EHRE usually appears in normotensive patients and patients with no previous CVD&#44; although the mechanisms involved and their clinical relevance are still poorly understood&#46; A recent review of 78&#44;163 normotensive individuals supports the relationship between EHRE and the development of AHT and CVD&#44; revealing the need for cardiovascular prevention for these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The pathophysiological mechanisms involved in EHRE are increasingly well known&#44; such that there is consensus that patients with EHRE have impaired endothelial function&#44; reduced nitric oxide levels&#44; increased arterial stiffness and impaired neurohormonal response characterized by excessive activation of the sympathetic nervous system&#44; as well as high angiotensin II levels&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7&#8211;9</span></a> It therefore seems reasonable to consider individuals with EHRE to be exposed to a greater preload of the left ventricle&#44; left ventricular hypertrophy and&#44; ultimately&#44; the onset of secondary subendocardial ischemia&#59; however&#44; the data on the association of EHRE and myocardial ischemia are limited and controversial&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> The data published by Bouzas-Mosquera et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> in the current issue of <span class="elsevierStyleSmallCaps">Revista Cl&#237;nica Espa&#241;ola</span> provide new evidence on the relationship between EHRE and myocardial ischemia in patients with previous ischemic heart disease&#46; In this study&#44; there was no significant relationship between EHRE and the electrocardiographic abnormalities of ischemia&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion and based on the available evidence&#44; it seems prudent to promote the early diagnosis of AHT&#44; encourage physical exercise for patients with AHT and prevent the onset of future CVD in normotensive patients with EHRE&#46; However&#44; the lack of strong criteria for defining EHRE and the lack of available evidence on the clinical management of normotensive patients with EHRE reveals the need for new prospective clinical studies to clarify these issues&#46;</p></span>"
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