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Wang J, Zheng Z, Zhang Y. Association of postexercise blood pressure with cardiovascular outcomes and mortality: The CARDIA study. J Clin Hypertens (Greenwich) 2024; 26:491-499. [PMID: 38501750 PMCID: PMC11088424 DOI: 10.1111/jch.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
Postexercise blood pressure (BP) may be a better predictor of cardiovascular risk than office BP, but there is a lack of data supporting this claim. We hypothesized that postexercise BP may be an important prognostic marker. Our aim was to evaluate the association of postexercise BP with major adverse cardiovascular events (MACE) and all-cause mortality. A total of 2581 participants (median age, 46 years; 55.9% women) from the Coronary Artery Risk Development in Young Adults study at year 20 (2005-2006) who underwent a graded exercise treadmill test using a modified Balke graded protocol were included. Postexercise BP was measured at baseline. Cox models were used to estimate the associations of postexercise BP with MACE and all-cause mortality. Participants were followed up until December 31, 2021. In the entire population, postexercise systolic BP showed no significant association with MACE or all-cause mortality, while postexercise diastolic BP was associated with MACE (hazard ratios [HR], 1.27 [95% CI, 1.06-1.52], per 10 mmHg increase) and all-cause mortality (HR, 1.26 [95% CI, 1.05-1.51], per 10 mmHg increase). In the normal BP group, postexercise systolic BP was not significantly associated with MACE or all-cause mortality, and postexercise diastolic BP was strongly associated with MACE (HR, 1.57 [95% CI, 1.18-2.09], per 10 mmHg increase). In this population-based cohort study, postexercise diastolic BP was significantly associated with the risk of MACE and all-cause mortality. Among individuals with normal BP, postexercise diastolic BP could identify those at a higher risk of cardiovascular events.
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Affiliation(s)
- Jia‐Jie Wang
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of CardiologyGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Zhichao Zheng
- Department of CardiologyGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
| | - Ying Zhang
- The Second School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of CardiologyGuangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouChina
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Kiviniemi AM, Kenttä TV, Lepojärvi S, Perkiömäki JS, Piira OP, Ukkola O, Huikuri HV, Junttila MJ, Tulppo MP. Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes. Diabetes Res Clin Pract 2019; 150:150-157. [PMID: 30872066 DOI: 10.1016/j.diabres.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/05/2019] [Indexed: 01/09/2023]
Abstract
AIMS To investigate prognostic significance of post-exercise recovery of rate-pressure product (RPP) in patients with stable coronary artery disease (CAD) and type 2 diabetes (T2D). METHODS Patients with angiographically documented CAD and T2D (n = 697) underwent symptom-limited bicycle exercise test. Exercise capacity (EC), heart rate, blood pressure and RPP responses to peak exercise and recovery (2' and 5' after cessation of exercise) were analyzed. Cardiac death was the primary and sudden cardiac death (SCD) secondary endpoint. RESULTS During a median follow-up of 76 months, 49 cardiac deaths (7.0%) and 28 SCDs (4.0%) were observed. The recovery of RPP at 5' was the strongest univariate predictor of cardiac death (hazard ratio [HR]: 2.55 per SD decrease, 95%CI: 1.82-3.58, p < 0.001) and SCD (HR: 2.34, 95%CI: 1.51-3.62, p < 0.001). In multivariate analysis, it remained significantly associated to cardiac death and SCD without (HR: 1.66, 95%CI: 1.14-2.41, p < 0.01 and HR: 1.75, 95%CI: 1.08-2.85, p < 0.05, respectively) and with additional adjustment for EC and peak RPP (HR: 1.45, 95%CI: 1.09-1.92, p < 0.05 and HR: 1.52, 95%CI: 1.01-2.27, p < 0.05, respectively). CONCLUSIONS The recovery of RPP after exercise is a potent predictor of cardiac death in patients with CAD and T2D. It provides significant prognostic information beyond EC and peak RPP.
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Affiliation(s)
- Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Samuli Lepojärvi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olli-Pekka Piira
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Roseguini BT, Hirai DM, Alencar MC, Ramos RP, Silva BM, Wolosker N, Neder JA, Nery LE. Sildenafil improves skeletal muscle oxygenation during exercise in men with intermittent claudication. Am J Physiol Regul Integr Comp Physiol 2014; 307:R396-404. [DOI: 10.1152/ajpregu.00183.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction caused by defective nitric oxide (NO) signaling plays a pivotal role in the pathogenesis of intermittent claudication (IC). In the present study, we evaluated the acute effects of sildenafil, a phosphodiesterase type 5 inhibitor that acts by prolonging NO-mediated cGMP signaling in vascular smooth muscle, on blood pressure (BP), skeletal muscle oxygenation, and walking tolerance in patients with IC. A randomized, double-blind, crossover study was conducted in which 12 men with stable IC received two consecutive doses of 50 mg of sildenafil or matching placebo and underwent a symptom-limited exercise test on the treadmill. Changes in gastrocnemius deoxy-hemoglobin by near-infrared spectroscopy estimated peripheral muscle O2delivery-to-utilization matching. Systolic BP was significantly lower during the sildenafil trial relative to placebo during supine rest (∼15 mmHg), submaximal exercise (∼14 mmHg), and throughout recovery (∼18 mmHg) ( P < 0.05). Diastolic BP was also lower after sildenafil during upright rest (∼6 mmHg) and during recovery from exercise (∼7 mmHg) ( P < 0.05). Gastrocnemius deoxygenation was consistently reduced during submaximal exercise (∼41%) and at peak exercise (∼34%) following sildenafil compared with placebo ( P < 0.05). However, pain-free walking time (placebo: 335 ± 42 s vs. sildenafil: 294 ± 35 s) and maximal walking time (placebo: 701 ± 58 s vs. sildenafil: 716 ± 62 s) did not differ between trials. Acute administration of sildenafil lowers BP and improves skeletal muscle oxygenation during exercise but does not enhance walking tolerance in patients with IC. Whether the beneficial effects of sildenafil on muscle oxygenation can be sustained over time and translated into positive clinical outcomes deserve further consideration in this patient population.
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Affiliation(s)
- Bruno T. Roseguini
- Pulmonary Function and Clinical Exercise Physiology Unit, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Daniel M. Hirai
- Pulmonary Function and Clinical Exercise Physiology Unit, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Maria C. Alencar
- Pulmonary Function and Clinical Exercise Physiology Unit, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Roberta P. Ramos
- Pulmonary Function and Clinical Exercise Physiology Unit, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Bruno M. Silva
- Department of Physiology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Nelson Wolosker
- Department of Surgery, Division of Vascular Surgery, University of Sao Paulo, Sao Paulo, Brazil; and
| | - J. Alberto Neder
- Pulmonary Function and Clinical Exercise Physiology Unit, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
- Queen's University and Kingston General Hospital, Laboratory of Clinical Exercise Physiology, Department of Medicine, Kingston, Ontario, Canada
| | - Luiz E. Nery
- Pulmonary Function and Clinical Exercise Physiology Unit, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
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Nishiyama Y, Sakaue A, Matsuo S, Niiyama H, Harada H, Katoh A, Ikeda H. Systolic blood pressure during recovery from exercise is related to flow-mediated dilatation in patients with coronary artery disease. HEART ASIA 2014; 6:83-6. [PMID: 27326176 DOI: 10.1136/heartasia-2013-010457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 04/07/2014] [Accepted: 05/18/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the relationship between exercise-induced parameters obtained from the routine exercise stress testing (EST) and flow-mediated vasodilatation (FMD) as an index of endothelial function. DESIGN A retrospective study. SETTING Kurume University Medical Center, Kurume, Japan. PATIENTS All patients with stable coronary artery disease (CAD) who were admitted to Kurume University Medical Center. MAIN OUTCOME MEASURE Results of EST and FMD. RESULTS We studied 66 patients (35 male/31 female) with CAD. All patients underwent symptom-limited EST and measurement of FMD. Exercise parameters included exercise-induced heart rate and systolic blood pressure (SBP). FMD did not differ between male and female groups. In univariate analysis, determinants of FMD included age and the change in SBP at 1 min after exercise. In Cox hazard model analysis, the change in SBP at 1 min after exercise (p=0.011) was an independent determinant of FMD. FMD in patients with abnormal SBP response group was significantly lower than that in normal SBP response group (4.2±1.8 ns. 6.1±2.6%, p<0.05). CONCLUSIONS These findings suggest that SBP during recovery from exercise is associated with endothelial function in patients with CAD.
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Affiliation(s)
- Yasuhiro Nishiyama
- Department of Cardiology , Kurume University Medical Center , Kurume, Kumamoto , Japan
| | - Akiko Sakaue
- Department of Cardiology , Kurume University Medical Center , Kurume, Kumamoto , Japan
| | - Sumitake Matsuo
- Department of Cardiology , Kurume University Medical Center , Kurume, Kumamoto , Japan
| | - Hiroshi Niiyama
- Department of Cardiology , Kurume University Medical Center , Kurume, Kumamoto , Japan
| | - Haruhito Harada
- Department of Cardiology , Kurume University Medical Center , Kurume, Kumamoto , Japan
| | - Atsushi Katoh
- Department of Cardiology , Kurume University Medical Center , Kurume, Kumamoto , Japan
| | - Hisao Ikeda
- Department of Cardiology , Kurume University Medical Center , Kurume, Kumamoto , Japan
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Chaturvedi N, Bathula R, Shore AC, Panerai R, Potter J, Kooner J, Chambers J, Hughes AD. South Asians have elevated postexercise blood pressure and myocardial oxygen consumption compared to Europeans despite equivalent resting pressure. J Am Heart Assoc 2013; 1:e000281. [PMID: 23316281 PMCID: PMC3541621 DOI: 10.1161/jaha.111.000281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 04/19/2012] [Indexed: 11/23/2022]
Abstract
Background Stroke mortality rate is higher in South Asians than in Europeans, despite equivalent or lower resting blood pressure (BP). Elevated recovery BP after exercise predicts stroke, independently of resting values. We hypothesized that South Asians would have adverse postexercise hemodynamics and sought explanations for this. Methods and Results A population-based sample of 147 European and 145 South Asian middle-aged men and women performed the Dundee 3-minute step test. Cardiovascular risk factors were measured. BP, heart rate, and rate–pressure product, a measure of myocardial oxygen consumption, were compared. With 90% power and 5% significance, we could detect a difference of 0.38 of a standard deviation in any outcome measure. Resting systolic BP was similar in South Asians (144 mm Hg) and Europeans (142 mm Hg) (P=0.2), as was exercise BP (P=0.4). However, recovery systolic BP at 3 minutes after exercise was higher in South Asians by 4.3 mm Hg (95% confidence interval [CI], 0.2 to 8.3 mm Hg; P=0.04). This effect persisted when adjusted for exercise BP and work effort (5.4 mm Hg [95% CI, 2.2 to 8.7 mm Hg; P=0.001]). Adjustment for baroreflex insensitivity and greater aortic stiffness in South Asians contributes greatly to attenuating this ethnic difference (1.9 mm Hg [95% CI, −0.9 to 4.6 mm Hg; P=0.4]). Similarly, rate–pressure product recovery after exercise was impaired in South Asians by 735 mm Hg/min (95% CI, 137 to 1334 mm Hg/min; P=0.02); again, adjustment for baroreflex insensitivity and aortic stiffness attenuated this difference (261 mm Hg/min [95% CI, −39 to 561 mm Hg/min; P=0.3]). Conclusion Postexercise recovery of BP and rate–pressure product is impaired in South Asians compared to Europeans even though resting and exercise BP are similar. This is associated with the autonomic dysfunction and aortic stiffness in South Asians. (J Am Heart Assoc. 2012;1:e000281 doi: 10.1161/JAHA.111.000281.)
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Affiliation(s)
- Nish Chaturvedi
- National Heart and Lung Institute, Imperial College Academic Health Sciences Centre, London, UK.
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He ZH, Hu Y, Li YC, Bao DP, Ruiz JR, Lucia A. Polymorphisms in the calcineurin genes are associated with the training responsiveness of cardiac phenotypes in Chinese young adults. Eur J Appl Physiol 2010; 110:761-7. [DOI: 10.1007/s00421-010-1558-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2010] [Indexed: 12/25/2022]
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Le VV, Mitiku T, Sungar G, Myers J, Froelicher V. The Blood Pressure Response to Dynamic Exercise Testing: A Systematic Review. Prog Cardiovasc Dis 2008; 51:135-60. [PMID: 18774013 DOI: 10.1016/j.pcad.2008.07.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vy-Van Le
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304-1207, USA.
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