1
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Cagan Efe S, Buğrahan Cicek M, Unkun T, Yucel E, Karagöz A, Doğan C, Bayram Z, Tekatlı AF, Bozan B, Karaçam M, Halil GS, Karabağ T, Kaymaz C, Ozdemir N. Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing. J Clin Hypertens (Greenwich) 2024; 26:687-695. [PMID: 38605567 PMCID: PMC11180695 DOI: 10.1111/jch.14814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105 mmHg in males ≥190/105 mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients' echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (-20.6 ± -2.3, -19.7 ± -1.9, p:.13; -21.3 ± -2.7, -21 ± -2.4, p:.68; -21.2 ± -2.2, -21.2 ± -2.3, p:.93; and -20.8 ± -1.5, -20.4 ± -1.5, p:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374 ± 210, 2465 ± 204, p:.10; 142 ± 64, 127 ± 42, p:.31; 94.3 ± 2.5, 95.1 ± 1.5, p:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036 ± 149, 2147 ± 150, p < .001). The GWI was independently associated with EBPRE (odds ratio with 95% 3.32 (1.02-11.24), p = .03). The partial effect plots were used for GWI to predict EBPRE, according to the results, an increase in GWI predicts probability of exaggerated hypertensive response. In conclusion, Myocardial work analyses might be used to identify early signs of myocardial involvement in normotensive patients with EBPRE.
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Affiliation(s)
- Süleyman Cagan Efe
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Mahmut Buğrahan Cicek
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Tuba Unkun
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Enver Yucel
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Ali Karagöz
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Cem Doğan
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Zübeyde Bayram
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Ali Furkan Tekatlı
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Baver Bozan
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Murat Karaçam
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Gülümser Sevgin Halil
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Turgut Karabağ
- Department of CardiologyIstanbul Education and Research HospitalIstanbulTurkey
| | - Cihangir Kaymaz
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Nihal Ozdemir
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
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2
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Yoon ES, Kim YJ. Exercise-induced Hypertension and Carotid Intima-media Thickness in Male Marathon Runners. Int J Sports Med 2024; 45:519-525. [PMID: 38365217 PMCID: PMC11216809 DOI: 10.1055/a-2270-3127] [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: 07/05/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
This study aimed to identify the relationship between exercise-induced hypertension and carotid artery intima-media thickness in long-distance runners. Sixty healthy male runners aged 40 to 60 years were assigned to the following three groups based on resting blood pressure and maximal systolic blood pressure during a maximal exercise test: normal blood pressure response, exercise-induced hypertension, and complex hypertension. An exaggerated systolic blood pressure response was defined as a maximal systolic blood pressure+≥+210 mmHg during the maximal exercise test, while carotid intima-media thickness was measured using B-mode ultrasonography. The carotid intima-media thickness mean values were the highest in the complex hypertension group (0.72±0.11 mm), followed by exercise-induced hypertension (0.62±0.12 mm) and normal blood pressure groups (0.55±0.13 mm), with a significant difference between the groups (p+<+0.002). In linear regression analysis, the mean intima-media thickness was independently associated with age (p=0.015) and maximal systolic blood pressure (p=0.046) but not with resting systolic blood pressure. These results suggest that exercise-induced hypertension is associated with carotid intima-media thickness, a surrogate marker of cardiovascular disease, in long-distance runners. Therefore, evaluating the blood pressure response during exercise is important for the early detection of potential cardiovascular disease risks in long-distance runners.
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Affiliation(s)
- Eun Sun Yoon
- Sports for All, Korea National Open University, Jongno-gu, Korea (the
Republic of)
| | - Young-Joo Kim
- Department of Exercise Rehabilitation & Welfare, Sungshin
Women's University, Seongbuk-gu, Korea (the Republic of)
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3
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Butenas ALE, Ishizawa R, Rollins KS, Mizuno M, Copp SW. Sex-dependent attenuating effects of capsaicin administration on the mechanoreflex in healthy rats. Am J Physiol Heart Circ Physiol 2023; 325:H372-H384. [PMID: 37389947 PMCID: PMC10396229 DOI: 10.1152/ajpheart.00237.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
Stimulation of mechanically sensitive channels on the sensory endings of group III and IV thin fiber muscle afferents activates the mechanoreflex, which contributes to reflex increases in sympathetic nerve activity (SNA) and blood pressure during exercise. Accumulating evidence suggests that activation of the nonselective cation channel transient receptor potential vanilloid-1 (TRPV1) on the sensory endings of thin fiber afferents with capsaicin may attenuate mechanosensation. However, no study has investigated the effect of capsaicin on the mechanoreflex. We tested the hypothesis that in male and female decerebrate, unanesthetized rats, the injection of capsaicin (0.05 µg) into the arterial supply of the hindlimb reduces the pressor and renal SNA (RSNA) response to 30 s of 1 Hz rhythmic hindlimb muscle stretch (a model of isolated mechanoreflex activation). In male rats (n = 8), capsaicin injection significantly reduced the integrated blood pressure (blood pressure index or BPI: pre, 363 ± 78; post, 211 ± 88 mmHg·s; P = 0.023) and RSNA [∫ΔRSNA; pre, 687 ± 206; post, 216 ± 80 arbitrary units (au), P = 0.049] response to hindlimb muscle stretch. In female rats (n = 8), capsaicin injection had no significant effect on the pressor (BPI; pre: 277 ± 67; post: 207 ± 77 mmHg·s; P = 0.343) or RSNA (∫ΔRSNA: pre, 697 ± 123; post, 440 ± 183 au; P = 0.307) response to hindlimb muscle stretch. The data suggest that the injection of capsaicin into the hindlimb arterial supply to stimulate TRPV1 on the sensory endings of thin fiber muscle afferents attenuates the mechanoreflex in healthy male, but not female, rats. The findings may carry important implications for chronic conditions in which an exaggerated mechanoreflex contributes to aberrant sympathoexcitation during exercise.NEW & NOTEWORTHY Recent evidence in isolated sensory neurons indicates that capsaicin-induced stimulation of TRPV1 attenuates mechanosensitivity. Here we demonstrate for the first time that capsaicin exposure/administration reduces the reflex pressor and renal sympathetic nerve response to mechanoreflex activation in male rats, but not female rats, in vivo. Our data may carry important clinical implications for chronic diseases which have been linked to an exaggerated mechanoreflex, at least in males.
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Affiliation(s)
- Alec L E Butenas
- Department of Kinesiology, Kansas State University, Manhattan, Kansas, United States
| | - Rie Ishizawa
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Korynne S Rollins
- Department of Kinesiology, Kansas State University, Manhattan, Kansas, United States
| | - Masaki Mizuno
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Steven W Copp
- Department of Kinesiology, Kansas State University, Manhattan, Kansas, United States
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4
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Nayor M, Gajjar P, Murthy VL, Miller P, Velagaleti RS, Larson MG, Vasan RS, Lewis GD, Mitchell GF, Shah RV. Blood Pressure Responses During Exercise: Physiological Correlates and Clinical Implications. Arterioscler Thromb Vasc Biol 2023; 43:163-173. [PMID: 36384270 PMCID: PMC9780190 DOI: 10.1161/atvbaha.122.318512] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Abnormal blood pressure (BP) responses to exercise can predict adverse cardiovascular outcomes, but their optimal measurement and definitions are poorly understood. We combined frequently sampled BP during cardiopulmonary exercise testing with vascular stiffness assessment to parse cardiac and vascular components of exercise BP. METHODS Cardiopulmonary exercise testing with BP measured every two minutes and resting vascular tonometry were performed in 2858 Framingham Heart Study participants. Linear regression was used to analyze sex-specific exercise BP patterns as a function of arterial stiffness (carotid-femoral pulse wave velocity) and cardiac-peripheral performance (defined by peak O2 pulse). RESULTS Our sample was balanced by sex (52% women) with mean age 54±9 years and 47% with hypertension. We observed variability in carotid-femoral pulse wave velocity and peak O2 pulse across individuals with clinically defined exercise hypertension (peak systolic BP [SBP] in men ≥210 mm Hg; in women ≥190 mm Hg). Despite similar resting SBP and cardiometabolic profiles, individuals with higher peak O2 pulse displayed higher peak SBP (P≤0.017) alongside higher fitness levels (P<0.001), suggesting that high peak exercise SBP in the context of high peak O2 pulse may in fact be favorable. Although both higher (favorable) O2 pulse and higher (adverse) arterial stiffness were associated with greater peak SBP (P<0.0001 for both), the magnitude of association of carotid-femoral pulse wave velocity with peak SBP was higher in women (sex-carotid-femoral pulse wave velocity interaction P<0.0001). In sex-specific models, exercise SBP measures accounting for workload (eg, SBP during unloaded exercise, SBP at 75 watts, and SBP/workload slope) were directly associated with the adverse features of greater arterial stiffness and lower peak O2 pulse. CONCLUSIONS Higher peak exercise SBP reflects a complex trade-off between arterial stiffness and cardiac-peripheral performance that differs by sex. Studies of BP responses to exercise accounting for vascular and cardiac physiology may illuminate mechanisms of hypertension and clarify clinical interpretation of exercise BP.
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Affiliation(s)
- Matthew Nayor
- Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Preventive Medicine and Epidemiology Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
| | - Priya Gajjar
- Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Venkatesh L. Murthy
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor
| | - Patricia Miller
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Raghava S. Velagaleti
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
- Cardiology Section, Department of Medicine, Boston VA Healthcare System, West Roxbury, Massachusetts
| | - Martin G. Larson
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Ramachandran S. Vasan
- Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Preventive Medicine and Epidemiology Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
- University of Texas School of Public Health San Antonio, and Departments of Medicine and Population Health Sciences, University of Texas Health Science Center, San Antonio, TX
- Department of Epidemiology, Boston University School of Public Health, and the Center for Computing and Data Sciences, Boston University, Boston, MA
| | - Gregory D. Lewis
- Cardiology Division and Pulmonary Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Ravi V. Shah
- Vanderbilt Translational and Clinical Research Center, Cardiology Division, Vanderbilt University Medical Center, Nashville, TN
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5
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Coronary flow velocity reserve is reduced in patients with an exaggerated blood pressure response to exercise. Hypertens Res 2022; 45:1653-1663. [DOI: 10.1038/s41440-022-00995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/18/2022] [Accepted: 06/23/2022] [Indexed: 11/09/2022]
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6
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Broxterman RM, La Salle DT, Zhao J, Reese VR, Kwon OS, Richardson RS, Trinity JD. Dietary Nitrate Supplementation and Small Muscle Mass Exercise Hemodynamics in Patients with Essential Hypertension. J Appl Physiol (1985) 2022; 133:506-516. [PMID: 35834624 PMCID: PMC9377785 DOI: 10.1152/japplphysiol.00218.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exaggerated blood pressure and diminished limb hemodynamics during exercise in patients with hypertension often are not resolved by antihypertensive medications. We hypothesized that, independent of antihypertensive medication status, dietary nitrate supplementation would increase limb blood flow, decrease mean arterial pressure (MAP), and increase limb vascular conductance during exercise in patients with hypertension. Patients with hypertension either abstained from (n=14, Off-Meds) or continued (n=12, On-Meds) antihypertensive medications. Within each group, patients consumed (cross-over design) nitrate-rich or nitrate-depleted (placebo) beetroot juice for 3-days before performing handgrip (HG) and knee-extensor exercise (KE). Blood flow and MAP were measured using Doppler ultrasound and an automated monitor, respectively. Dietary nitrate increased plasma-[nitrite] Off-Meds and On-Meds. There were no significant effects of dietary nitrate on blood flow, MAP, or vascular conductance during HG in Off-Meds or On-Meds. For KE, dietary nitrate decreased MAP (mean±SD across all three exercise intensities, 118±14 vs. 122±14 mmHg, p=0.024) and increased vascular conductance (26.2±6.1 vs. 24.7±7.0 ml/min/mmHg, p=0.024), but did not affect blood flow for Off-Meds, with no effects On-Meds. Dietary nitrate-induced changes in blood flow (r=-0.67, p<0.001), MAP (r=-0.43, p=0.009), and vascular conductance (r=-0.64, p<0.001) during KE, but only vascular conductance (r=-0.35, p=0.039) during HG, were significantly related to the magnitude of placebo values, with no differentiation between groups. Thus, the effects of dietary nitrate on limb hemodynamics and MAP during exercise in patients with hypertension are dependent on the values at baseline, independent of antihypertensive medication status, and dependent on whether exercise was performed by the forearm or quadriceps.
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Affiliation(s)
- Ryan M Broxterman
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, Salt Lake City, UT, United States.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Center on Aging, University of Utah, Salt Lake City, UT, United States
| | - D Taylor La Salle
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| | - Jia Zhao
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Van R Reese
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Oh Sung Kwon
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States.,Department of Orthopedic Surgery and Center of Aging, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, Salt Lake City, UT, United States.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Center on Aging, University of Utah, Salt Lake City, UT, United States.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| | - Joel D Trinity
- Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC, Salt Lake City, UT, United States.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States.,Center on Aging, University of Utah, Salt Lake City, UT, United States.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
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7
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Palermi S, Sirico F, Fernando F, Gregori G, Belviso I, Ricci F, D'Ascenzi F, Cavarretta E, De Luca M, Negro F, Montagnani S, Niebauer J, Biffi A. Limited diagnostic value of questionnaire-based pre-participation screening algorithms: a "risk-exposed" approach to sports activity. J Basic Clin Physiol Pharmacol 2022; 33:655-663. [PMID: 35647906 DOI: 10.1515/jbcpp-2022-0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several pre-participation screening algorithms (PPSAs) have been proposed to assess sports eligibility in different populations. They are usually based on self-administered questionnaires, without further medical assessment if no risk factors are documented. The Med-Ex "Formula Benessere" worksite program includes a complete cardiovascular (CV) screening for all participants. The purpose of this study was to assess PPSAs accuracy in detecting medical and/or CV abnormalities in the general population, comparing the results with the date derived from Med-Ex program. METHODS The Med-Ex medical evaluation, consisting of medical history, physical examination (including body composition), resting electrocardiogram (ECG) and exercise stress test in 464 male subjects (38.4 aged) was analyzed and matched to several PPSAs - Physical Activity Readiness Questionnaire (PAR-Q) (2002-2020), American Heart Association (AHA)/American College of Sport Medicine (ACSM) (1998-2009-2014-2015), European Association of Cardiovascular Prevention and Rehabilitation (EACPR) (2011) - retrospectively simulated. RESULTS Five-hundred and 67 abnormalities were detected though Med-Ex medical evaluation, and one-fourth (24%) would have been undetected applying PPSA alone. In particular 28% of high blood pressure, 21% of impaired fasting glycaemia, 21% of high Body Mass Index (BMI) values and 19% of ECG abnormalities would have been missed, on average, by all PPSAs. CONCLUSIONS The simulation analysis model performed in this study allowed to highlight the limits of PPSAs in granting sport eligibility, compared to a medical-guided CV screening. These findings emphasize the importance of a more balanced approach to pre-participation screening that includes a thorough evaluation of the cost/benefit ratio.
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Affiliation(s)
- Stefano Palermi
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy.,Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Felice Sirico
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy.,Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fredrick Fernando
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Giampietro Gregori
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Immacolata Belviso
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, "G. d'Annunzio" University, Chieti, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Francesco Negro
- Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Stefania Montagnani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Alessandro Biffi
- Med-Ex, Medicine & Exercise srl, Medical Partner Scuderia Ferrari, Rome, Italy
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8
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Wuestenfeld JC, Baersch F, Ruedrich P, Paech C, Wolfarth B. Blood pressure response to dynamic exercise testing in adolescent elite athletes, what is normal? Front Pediatr 2022; 10:974926. [PMID: 36340728 PMCID: PMC9635448 DOI: 10.3389/fped.2022.974926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In general, only few studies are dedicated to blood pressure behavior under physical stress in children and adolescents. Even less is published about the blood pressure behavior of young high-performance athletes on the ergometer. For this reason, we evaluated the blood pressure behavior under stress compared to non-athletes in a large collective (n = 739) of young high-performance athletes (age 10-20 years, mean 15.8 years, male 442, female 297) of different sports. A complete echocardiographic examination was available in all athletes. RESULT Regardless of gender, the young competitive athletes achieved significantly higher maximum blood pressure values than investastigated populations from previous studies. Based on the data obtained, blood pressure percentiles are now defined explicitly for junior athletes across sports as well as age- and gender-dependent, which did not exist in this form of normal values for the special clientele of young competitive athletes. The echocardiographic examinations demonstrated stress-induced cardiac adaptation adaptations in the majority of athletes, which thus correlate with the comparatively higher stress blood pressures compared to non-athletes. CONCLUSION For the first time, blood pressure percentiles for exercise tests on the ergometer for age groups and gender in high performance athletes are defined based on a comparatively large collective of young competitive athletes. Upper limits were determined, in particular for systolic blood pressure under stress, and categorized according to gender and age. Performance diagnosticians and physicians are now enabled to make a more accurate assessment of the corresponding blood pressure regulation of young athletes under exercise conditions.
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Affiliation(s)
- J C Wuestenfeld
- Department Sports Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Berlin, Germany.,Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
| | - F Baersch
- Faculty of Sports Science, Institut of Sports Medicine, University Leipzig, Leipzig, Germany
| | - P Ruedrich
- Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
| | - C Paech
- Department for Pediatric Cardiology, University of Leipzig -Heart Center Leipzig, Leipzig, Germany
| | - B Wolfarth
- Department Sports Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Berlin, Germany.,Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
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9
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Clarke MM, Zannino D, Stewart NP, Glenning JP, Pineda-Guevara S, Kik J, Mynard JP, Cheung MMH. Normative blood pressure response to exercise stress testing in children and adolescents. Open Heart 2021; 8:openhrt-2021-001807. [PMID: 34663749 PMCID: PMC8524376 DOI: 10.1136/openhrt-2021-001807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
Objective To describe normative values for blood pressure (BP) response to maximal exercise in children/adolescents undergoing a treadmill stress test. Methods From a retrospective analysis of medical records, patients who had undergone a Bruce protocol exercise stress test, with (1) normal cardiovascular system and (2) a body mass index percentile rank below 95% were included for analysis. Sex, age, height, weight, resting and peak heart rate, resting and peak systolic blood pressure (SBP), test duration, stage of Bruce protocol at termination, reason for undergoing the test and reason for termination of test were collected. Percentiles for exercise-induced changes in SBP were constructed by age and height for each sex with the use of quantile regression models. Results 648 patients with a median age of 12.4 years (range 6–18 years) were included. Typical indications for stress testing were investigation of potential rhythm abnormalities, syncope/dizziness and chest pain and were deemed healthy by an overseeing cardiologist. Mean test duration was 12.6±2.2 min. Reference percentiles for change in SBP by sex, age and height are presented. Conclusion The presented reference percentiles for the change in SBP for normal children and adolescents will have utility for detecting abnormally high or low BP responses to exercise in these age groups.
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Affiliation(s)
- Melanie M Clarke
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Natalie P Stewart
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jonathan P Glenning
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | | | - Jolien Kik
- Department of Cardiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Medical Education, University of Groningen, Groningen, The Netherlands
| | - Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Biomedical Engineering, Faculty of Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Cardiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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10
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The association of elevated blood pressure during ischaemic exercise with sport performance in Master athletes with and without morbidity. Eur J Appl Physiol 2021; 122:211-221. [PMID: 34652528 PMCID: PMC8748359 DOI: 10.1007/s00421-021-04828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022]
Abstract
Background An exaggerated exercise blood pressure (BP) is associated with a reduced exercise capacity. However, its connection to physical performance during competition is unknown. Aim To examine BP responses to ischaemic handgrip exercise in Master athletes (MA) with and without underlying morbidities and to assess their association with athletic performance during the World Master Track Cycling Championships 2019. Methods Forty-eight Master cyclists [age 59 ± 13yrs; weekly training volume 10.4 ± 4.1 h/week; handgrip maximum voluntary contraction (MVC) 46.3 ± 11.5 kg] divided into 2 matched groups (24 healthy MA and 24 MA with morbidity) and 10 healthy middle-aged non-athlete controls (age 48.3 ± 8.3 years; MVC 40.4 ± 14.8 kg) performed 5 min of forearm occlusion including 1 min handgrip isometric contraction (40%MVC) followed by 5 min recovery. Continuous beat-by-beat BP was recorded using finger plethysmography. Age-graded performance (AGP) was calculated to compare race performances among MA. Healthy Master cyclists were further grouped into middle-age (age 46.2 ± 6.4 years; N:12) and old-age (age 65.0 ± 7.7 years; N:12) for comparison with middle-aged non-athlete controls. Results Healthy and morbidity MA groups showed similar BP responses during forearm occlusion and AGP (90.1 ± 4.3% and 91.0 ± 5.3%, p > 0.05, respectively). Healthy and morbidity MA showed modest correlation between the BP rising slope for 40%MVC ischaemic exercise and AGP (r = 0.5, p < 0.05). MA showed accelerated SBP recovery after cessation of ischaemic handgrip exercise compared to healthy non-athlete controls. Conclusion Our findings associate long-term athletic training with improved BP recovery following ischaemic exercise regardless of age or reported morbidity. Exaggerated BP in Master cyclists during ischaemic exercise was associated with lower AGP during the World Master Cycling Championships. Supplementary Information The online version contains supplementary material available at 10.1007/s00421-021-04828-9.
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11
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Novel insights into stroke risk beyond resting and maximal bicycle exercise systolic blood pressure. J Hypertens 2021; 39:2022-2029. [PMID: 34102659 DOI: 10.1097/hjh.0000000000002894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Previous research has shown an association between moderate workload exercise blood pressure (BP) and coronary disease, whereas maximal exercise BP is associated with stroke. We aimed to investigate the association between the increase in BP during maximal exercise and the long-term risk of stroke in healthy, middle-aged men. METHODS Two thousand and fourteen men were included in the Oslo Ischemia Study in the 1970s. In the present study, we examined baseline data of the 1392 participants who remained healthy and performed bicycle exercise tests both at baseline and 7 years later. Cox proportional hazard was used to assess the risk of stroke in participants divided into quartiles based on the difference between resting and maximal workload SBP (ΔSBP) at baseline, adjusting for resting BP, age, smoking, serum cholesterol and physical fitness. Follow-up was until the first ischemic or hemorrhagic stroke through 35 years. RESULTS There were 195 incident strokes; 174 (89%) were ischemic. In univariate analyses, there were significant positive correlations between age, resting SBP, resting DBP and SBP at moderate and maximal workload, and risk of stroke. In the multivariate analysis, there was a 2.6-fold (P < 0.0001) increase in risk of stroke in ΔSBP quartile 4 (ΔSBP > 99 mmHg) compared with ΔSBP quartile 2 (ΔSBP 73-85 mmHg), which had the lowest risk of stroke. ΔSBP quartile 1 had a 1.7-fold (P = 0.02) increased risk compared with quartile 2, suggesting a J-shaped association to stroke risk. CONCLUSION Stroke risk increased with increasing difference between resting and maximal exercise SBP, independent of BP at rest, suggesting that an exaggerated BP response to physical exercise may be an independent predictor of stroke.
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12
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Assaf Y, Barout A, Alhamid A, Al-Mouakeh A, Barillas-Lara MI, Fortin-Gamero S, Bonikowske AR, Pepine CJ, Allison TG. Peak Systolic Blood Pressure During the Exercise Test: Reference Values by Sex and Age and Association With Mortality. Hypertension 2021; 77:1906-1914. [PMID: 33866799 DOI: 10.1161/hypertensionaha.120.16570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Yazan Assaf
- From the Department of Medicine, University of Florida, Gainesville (Y.A., C.J.P.)
| | - Ahmad Barout
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN.,Department of General Internal Medicine, University of Massachusetts, Worcester (A.B.)
| | - Ahmad Alhamid
- Faculty of Medicine, University of Aleppo, Syrian Arab Republic (A.A., A.A.-M.)
| | - Ahmad Al-Mouakeh
- Faculty of Medicine, University of Aleppo, Syrian Arab Republic (A.A., A.A.-M.)
| | - Maria Irene Barillas-Lara
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN.,Department of Medicine, Boston University, MA (M.I.B.-L.)
| | - Sonia Fortin-Gamero
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN
| | - Carl J Pepine
- From the Department of Medicine, University of Florida, Gainesville (Y.A., C.J.P.)
| | - Thomas G Allison
- Department of Cardiovascular Medicine (Y.A., A.B., M.I.B.-L., S.F.-G., A.R.B., T.G.A.), Mayo Clinic, Rochester, MN.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine (T.G.A.), Mayo Clinic, Rochester, MN
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13
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Carneiro HA, Song RJ, Lee J, Schwartz B, Vasan RS, Xanthakis V. Association of Blood Pressure and Heart Rate Responses to Submaximal Exercise With Incident Heart Failure: The Framingham Heart Study. J Am Heart Assoc 2021; 10:e019460. [PMID: 33759543 PMCID: PMC8174367 DOI: 10.1161/jaha.120.019460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Exercise stress tests are conventionally performed to assess risk of coronary artery disease. Using the FHS (Framingham Heart Study) Offspring cohort, we related blood pressure (BP) and heart rate responses during and after submaximal exercise to the incidence of heart failure (HF). Methods and Results We evaluated Framingham Offspring Study participants (n=2066; mean age, 58 years; 53% women) who completed 2 stages of an exercise test (Bruce protocol) at their seventh examination (1998-2002). We measured pulse pressure, systolic BP, diastolic BP, and heart rate responses during stage 2 exercise (2.5 mph at 12% grade). We calculated the changes in systolic BP, diastolic BP, and heart rate from stage 2 to recovery 3 minutes after exercise. We used Cox proportional hazards regression to relate each standardized exercise variable (during stage 2, and at 3 minutes of recovery) individually to HF incidence, adjusting for standard risk factors. On follow-up (median, 16.8 years), 85 participants developed new-onset HF. Higher exercise diastolic BP was associated with higher HF with reduced ejection fraction (ejection fraction <50%) risk (hazard ratio [HR] per SD increment, 1.26; 95% CI, 1.01-1.59). Lower stage 2 pulse pressure and rapid postexercise recovery of heart rate and systolic BP were associated with higher HF with reduced ejection fraction risk (HR per SD increment, 0.73 [95% CI, 0.57-0.94]; 0.52 [95% CI, 0.35-0.76]; and 0.63 [95% CI, 0.47-0.84], respectively). BP and heart rate responses to submaximal exercise were not associated with risk of HF with preserved ejection fraction (ejection fraction ≥50%). Conclusions Accentuated diastolic BP during exercise with slower systolic BP and heart rate recovery after exercise are markers of HF with reduced ejection fraction risk.
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Affiliation(s)
- Herman A Carneiro
- Internal Medicine Residency Program Boston University School of Medicine Boston MA
| | - Rebecca J Song
- Department of Epidemiology Boston University School of Public Health Boston MA
| | - Joowon Lee
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA
| | - Brian Schwartz
- Internal Medicine Residency Program Boston University School of Medicine Boston MA
| | - Ramachandran S Vasan
- Department of Epidemiology Boston University School of Public Health Boston MA.,Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Boston UniversityCenter for Computing and Data Sciences Boston MA.,Boston University and National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study) Framingham MA
| | - Vanessa Xanthakis
- Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine Department of Medicine Boston University School of Medicine Boston MA.,Boston University and National Heart, Lung, and Blood Institute's FHS (Framingham Heart Study) Framingham MA.,Department of Biostatistics Boston University School of Public Health Boston MA
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14
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Phoemsapthawee J, Sriton B. Combined exercise training improves blood pressure at rest and during exercise in young obese prehypertensive men. J Sports Med Phys Fitness 2020; 61:468-479. [PMID: 32975391 DOI: 10.23736/s0022-4707.20.11222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Regular exercise is an effective intervention to yield health-related benefits, though an optimal dosage and its ability to improve hemodynamics at rest and during exercise are yet to be established. Therefore, this study aimed to assess the effects of a combined (aerobic and resistance) exercise training program on hemodynamic variables at rest and during exercise in young obese prehypertensive men. METHODS Twenty obese prehypertensive men (age: 20±1.2 years) were randomly assigned to either the combined exercise training group (CBT, N.=10), or the control group (CON, N.=10). The CBT underwent a supervised combined exercise training program incorporating four 60-min sessions per week over 12 weeks, whereas the CON remained in habitual activities. We assessed BP, peak oxygen consumption (V̇O<inf>2peak</inf>), body composition, muscular strength, and hemodynamic responses to incremental exercise at baseline and post intervention. RESULTS The study revealed significant improvements in resting systolic blood pressure (SBP) of 4.3% (P<0.05), and rate-pressure product (RPP) of 11.3% (P<0.05) following 12 weeks of training. Significant reductions in SBP and RPP during exercise were also present at every exercise intensity. Moreover, the CBT training improved V̇O<inf>2peak</inf> by 18.2% (P<0.01), upper body muscle strength by 15.1% (P<0.01), and reduced body fat (P<0.01). CONCLUSIONS The CBT is effective in reducing SBP and myocardial oxygen demand at rest and during exercise. It can also improve cardiorespiratory fitness, muscular strength, and reduce body fat; especially in terms of abdominal obesity. Thus, we suggest the use of the CBT program for the prevention of future hypertension in young obese prehypertensive men.
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Affiliation(s)
- Jatuporn Phoemsapthawee
- Department of Sports Science and Health, Faculty of Sports Science, Kasetsart University, Nakhon Pathom, Thailand -
| | - Bhuwanat Sriton
- Department of Sports Science and Health, Faculty of Sports Science, Kasetsart University, Nakhon Pathom, Thailand
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15
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Santos LP, Umpierre D. Exercise, Cardiovascular Health, and Risk Factors for Atherosclerosis: A Narrative Review on These Complex Relationships and Caveats of Literature. Front Physiol 2020; 11:840. [PMID: 32848823 PMCID: PMC7411151 DOI: 10.3389/fphys.2020.00840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/22/2020] [Indexed: 12/20/2022] Open
Abstract
The following narrative review addresses the relationship between physical activity and exercise with cardiovascular health, focusing primarily on the following risk factors for atherosclerosis: hypertension, dyslipidemia, and vascular function. Cardiovascular diseases are intimately associated with mortality and morbidity, and current societal organization contributes to the incidence of cardiovascular events. A worldwide epidemiological transition to cardiovascular deaths was observed in the last century, with important decrements in physical activity and diet quality. An atherogenic environment started to be the new normal, with risk factors such as dyslipidemia, hypertension, and endothelial dysfunction observed in great portions of the population. Exercise is an important tool to improve overall health. For hypertension, a great amount of evidence now puts exercise as an effective therapeutic tool in the treatment of this condition. The effects of exercise in modifying blood lipid-lipoprotein are less clear. Despite the rationale remaining solid, methodological difficulties impair the interpretation of possible effects in these variables. Vascular function, as assessed by flow-mediated dilatation, is a good measure of overall vascular health and is consistently improved by exercise in many populations. However, in individuals with hypertension, the exercise literature still needs a further description of possible effects on vascular function variables. Physical activity and exercise are associated with improved cardiovascular health, especially with reduced blood pressure, and should be encouraged on the individual and population level. Evidence regarding its effects on blood lipids and flow-mediated dilatation still need solid landmark studies to guide clinical practice.
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Affiliation(s)
- Lucas P. Santos
- Exercise Pathophysiology Laboratory, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS/HCPA), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Umpierre
- Exercise Pathophysiology Laboratory, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- National Institute of Science and Technology for Health Technology Assessment (IATS/HCPA), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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16
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Lee J, Vasan RS, Xanthakis V. Association of Blood Pressure Responses to Submaximal Exercise in Midlife With the Incidence of Cardiovascular Outcomes and All-Cause Mortality: The Framingham Heart Study. J Am Heart Assoc 2020; 9:e015554. [PMID: 32431193 PMCID: PMC7428993 DOI: 10.1161/jaha.119.015554] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Few studies examined the associations of midlife blood pressure (BP) responses to submaximal exercise with the risk of cardiovascular outcomes and mortality in later life. Methods and Results We evaluated 1993 Framingham Offspring Study participants (mean age, 58 years; 53.2% women) attending examination cycle 7. We related BP responses to submaximal exercise with prevalent subclinical cardiovascular disease (CVD) using multivariable linear regression models. We also related BP responses to submaximal exercise to the incidence of hypertension, CVD, and all‐cause mortality using Cox proportional hazards regression models. Each SD increment of exercise BP was associated with higher log‐transformed left ventricular mass (systolic blood pressure [SBP], β=0.02, P=<0.001; diastolic blood pressure [DBP], β=0.01, P=0.004) and carotid intima‐media thickness (SBP, β=0.08, P=<0.001). Rapid BP recovery (per 1 SD increment) was associated with lower log left ventricular mass (SBPrecovery; β=−0.03, P=<0.001) and carotid intima‐media thickness (SBPrecovery, β=−0.07, P=0.003; DBPrecovery, β=−0.09, P=0.003). Additionally, Each SD increment of exercise BP was associated with a higher risk of incident hypertension (SBP, hazard ratio [HR], 1.40; 95% CI, 1.20–1.62; DBP, HR, 1.24; 95% CI, 1.11–1.40) and CVD (DBP, HR, 1.15; 95% CI, 1.02–1.30). Finally, the multivariable‐adjusted HR for each 1‐SD increment of BP recovery was 0.46 (SBPrecovery, 95% CI, 0.38–0.54) and 0.55 (DBPrecovery, 95% CI, 0.45–0.67) for hypertension; 0.80 (SBPrecovery, 95% CI, 0.69–0.93) for CVD; and 0.76 (SBPrecovery, 95% CI, 0.65–0.88) for all‐cause mortality. Conclusions Higher submaximal exercise BP and impaired BP recovery after submaximal exercise in midlife may be markers of subclinical and clinical CVD and mortality in later life.
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Affiliation(s)
- Joowon Lee
- Section of Preventive Medicine and Epidemiology Boston University Department of Medicine Boston MA
| | - Ramachandran S Vasan
- Section of Preventive Medicine and Epidemiology Boston University Department of Medicine Boston MA.,Department of Epidemiology Boston University School of Public Health Boston MA.,Framingham Heart Study Framingham MA
| | - Vanessa Xanthakis
- Section of Preventive Medicine and Epidemiology Boston University Department of Medicine Boston MA.,Department of Biostatistics Boston University School of Public Health Boston MA.,Framingham Heart Study Framingham MA
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17
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Fumagalli C, Maurizi N, Marchionni N, Fornasari D. β-blockers: Their new life from hypertension to cancer and migraine. Pharmacol Res 2019; 151:104587. [PMID: 31809852 DOI: 10.1016/j.phrs.2019.104587] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/28/2022]
Abstract
The pharmacological class of β-blockers includes a plea of molecules with largely different pharmacokinetic and pharmacodynamic characteristics with a protective effect that may span far beyond the cardiovascular system. Although all these compounds share the pharmacological blockade of the adrenergic receptors, each of them is characterized by specific pharmacological properties, including selectivity of action depending on the adrenergic receptors subtypes, intrinsic sympathomimetic activity (ISA), lipid solubility, pharmacokinetic profile, and also other ancillary properties that impact their clinical effect. Their use in the treatment of hypertension has been extensively debated and at the moment a class indication is not present. However, in specific niche of patients, such as in those young individuals in which hypertension is mainly driven by a sympathetic hyperactivation, strong evidence pose β-Blockers as a highly reasonable first-line treatment. Lipophilic β-blockers, specifically propranolol and metoprolol, can cross the Blood Brain Barrier and have a Class A indication for the prophylactic treatment of migraine attacks. Moreover, since β-adrenergic receptors affect the proliferative process of both cancer and immune cells, their blockade has been associated with metastasis reduction in several epithelial and solid organ tumors posing β-Blockers as a new attractive, inexpensive and relatively safe therapeutic strategy in patients with several types of cancer. However, further dedicated prospective, randomized, placebo-controlled studies are needed to determine the real efficacy of these compounds.
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Affiliation(s)
- Carlo Fumagalli
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Niccolò Maurizi
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy; Hopital du Valais, Department of Internal Medicine, Sion, Switzerland.
| | - Niccolò Marchionni
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy
| | - Diego Fornasari
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Italy
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Mariampillai JE, Liestøl K, Kjeldsen SE, Prestgaard EE, Engeseth K, Bodegard J, Berge E, Gjesdal K, Erikssen J, Grundvold I, Skretteberg PT. Exercise Systolic Blood Pressure at Moderate Workload Is Linearly Associated With Coronary Disease Risk in Healthy Men. Hypertension 2019; 75:44-50. [PMID: 31735088 DOI: 10.1161/hypertensionaha.119.13528] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There is no consensus on the definition of an exaggerated increase in systolic blood pressure (SBP) during exercise. The aim was to explore a potential threshold for exercise SBP associated with increased risk of coronary heart disease in healthy men using repeated exercise testing. Two thousand fourteen healthy white male employees were recruited into the Oslo Ischemia Study during early 1970s. At follow-up 7 years later, 1392 men were still considered healthy. A bicycle exercise test at 100 W workload was performed at both visits. Cox regression analyses were performed with increasing cutoff levels of peak exercise SBP at 100 W workload (SBP100W) from 160 mm Hg to 200 mm Hg, adjusted for cardiovascular risk factors and physical fitness. Participants with SBP100W below cutoff level at both baseline and first follow-up were compared with participants with SBP100W equal to or above cutoff level at both visits. Compared with participants with SBP100W below all cutoff levels between 165 and 195 mm Hg, coronary heart disease risk was increased among participants with SBP100W equal to or above cutoff at all levels. There was no evidence of a distinct threshold level for coronary heart disease risk, and the relation between SBP100W and coronary heart disease appears linear. When investigating exercise SBP at moderate workload measured at 2 exercise tests in healthy middle-aged white men, there is increasing risk of coronary heart disease with increasing exercise SBP independent of SBP at rest. The association is linear from the low range of exercise SBP, and there is no sign of a distinct threshold level for increased coronary disease risk.
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Affiliation(s)
- Julian E Mariampillai
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.)
| | - Knut Liestøl
- Institute of Informatics (K.L.), University of Oslo, Norway
| | - Sverre E Kjeldsen
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.).,Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Erik E Prestgaard
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.).,Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Kristian Engeseth
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.).,Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Johan Bodegard
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.)
| | - Eivind Berge
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.).,Institute of Clinical Medicine; University of Tromsø, Norway (E.B.)
| | - Knut Gjesdal
- Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Jan Erikssen
- Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Irene Grundvold
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.)
| | - Per T Skretteberg
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.)
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Bouzas-Mosquera MC, Bouzas Mosquera A, Peteiro J, Espina-Jerez B, Domínguez-Isabel P, Gómez Cantarino S. An exaggerated increase in blood pressure with exercise does not predict mortality or severe cardiovascular events in women referred for exercise echocardiography for clinical reasons. Rev Clin Esp 2019; 220:228-235. [PMID: 31722783 DOI: 10.1016/j.rce.2019.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/07/2019] [Accepted: 05/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The association between an exaggerated systolic blood pressure increase with exercise (EBPIE) and the probability of cardiovascular events is controversial and poorly studied in the female population. Our aim was to determine the possible association between EBPIE on one hand and mortality and cardiovascular events on the other in women referred for exercise echocardiography due to known or suspected coronary artery disease. PATIENTS AND METHODS A total of 3942 women with known or suspected coronary artery disease underwent exercise echocardiography. We defined EBPIE as a ≥70mm Hg increase in systolic blood pressure with exercise. The study endpoints were overall and cardiac mortality, acute myocardial infarction (MI), stroke and coronary revascularisation procedures. RESULTS A total of 332 women developed EBPIE during the test. During the follow-up, 458 deaths (162 of cardiac origin), 212 MIs, 89 strokes and 345 coronary revascularisation procedures were recorded. The annual rates of overall and cardiac mortality were lower in the patient subgroup with EBPIE (0.15% vs. 2.3%, P=.02 and 0.01% vs. 0.2%, P=.015, respectively). There were no significant differences in the rates of MI, stroke and the need for coronary revascularisation procedures, which occurred in 1.1%, 0.43% and 2.24% of the patients with EBPIE, respectively, and occurred in 0.09%, 0.05% and 0.13% of the women without EBPIE (P=.66; P=.57; P=.19, respectively). After a multivariate adjustment, EBPIE was not a predictor of mortality or cardiovascular events. CONCLUSIONS EBPIE is not associated with mortality or severe cardiovascular events in women with known or suspected coronary artery disease.
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Affiliation(s)
- M C Bouzas-Mosquera
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha, Toledo, España.
| | - A Bouzas Mosquera
- Departamento de Cardiología, Complexo Hospitalario Universitario de A Coruña, La Coruña, España
| | - J Peteiro
- Departamento de Cardiología, Complexo Hospitalario Universitario de A Coruña, La Coruña, España
| | | | | | - S Gómez Cantarino
- Departamento de Enfermería, Fisioterapia y Terapia Ocupacional, Universidad de Castilla la Mancha, Toledo, España
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20
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Millenaar D, Böhm M, Mahfoud F. Risk prediction with blood pressure during physical activity: A METter of exercise? Eur J Prev Cardiol 2019; 27:975-977. [PMID: 31657223 DOI: 10.1177/2047487319885038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dominic Millenaar
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
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Côté CE, Rhéaume C, Poirier P, Després JP, Alméras N. Deteriorated Cardiometabolic Risk Profile in Individuals With Excessive Blood Pressure Response to Submaximal Exercise. Am J Hypertens 2019; 32:945-952. [PMID: 31136645 DOI: 10.1093/ajh/hpz087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/19/2018] [Accepted: 05/27/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early identification of individuals at increased cardiometabolic risk is an essential step to improve primary preventive interventions. Excessive maximal exercise blood pressure (EBP) has been associated with several adverse outcomes. We examined how submaximal EBP could help us to identify individuals with a deteriorated cardiometabolic risk profile. METHODS Data from an observational study of 3,913 participants from a convenience sample were used. Subjects included in the analyses completed a comprehensive cardiometabolic health assessment (resting blood pressure [BP]; waist circumference; lipid profile; HbA1c; submaximal treadmill exercise test including a standardized stage [3.5 mph and 2% slope] with BP and heart rate measurements). Participants were classified on BP response at the standardized stage (Normal or Excessive Response). Excessive response was defined as systolic BP ≥ 80th percentile or diastolic BP ≥ 90 mmHg. Subjects were also classified into five resting BP subgroups according to current guidelines. RESULTS The Excessive Response group had more deteriorated cardiometabolic and cardiorespiratory profiles than the Normal Response group (P ≤ 0.01). The Excessive Response group also showed a greater proportion of carriers of the hypertriglyceridemic waist phenotype in most resting BP subgroups (P ≤ 0.05). Finally, excessive BP response to submaximal exercise showed an independent contribution on cardiometabolic and cardiorespiratory factors beyond age, sex, and resting BP. CONCLUSIONS This study demonstrates that an excessive BP response to a submaximal exercise is associated with a deteriorated cardiometabolic risk profile beyond resting BP profile. Therefore, submaximal EBP represents a simple screening tool to better identify at-risk individuals requiring aggressive preventive lifestyle interventions.
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Affiliation(s)
- Charles-Emanuel Côté
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Caroline Rhéaume
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, QC, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Faculty of Pharmacy, Université Laval, QC, Canada
| | - Jean-Pierre Després
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Natalie Alméras
- Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval, Québec, QC, Canada
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada
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22
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Hernesniemi JA, Sipilä K, Tikkakoski A, Tynkkynen JT, Mishra PP, Lyytikäinen LP, Nikus K, Nieminen T, Lehtimaki T, Kähönen M. Cardiorespiratory fitness and heart rate recovery predict sudden cardiac death independent of ejection fraction. Heart 2019; 106:434-440. [PMID: 31422363 DOI: 10.1136/heartjnl-2019-315198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate whether cardiorespiratory fitness (CRF) and heart rate recovery (HRR) associate with the risk of sudden cardiac death (SCD) independently of left ventricular ejection fraction (LVEF). METHODS The Finnish Cardiovascular Study is a prospective clinical study of patients referred to clinical exercise testing in 2001-2008 and follow-up until December 2013. Patients without pacemakers undergoing first maximal or submaximal exercise testing with cycle ergometer were included (n=3776). CRF in metabolic equivalents (METs) was estimated by achieving maximal work level. HRR was defined as the reduction in heart rate 1 min after maximal exertion. Adjudication of SCD was based on death certificates. LVEF was measured for clinical indications in 71.4% of the patients (n=2697). RESULTS Population mean age was 55.7 years (SD 13.1; 61% men). 98 SCDs were recorded during a median follow-up of 9.1 years (6.9-10.7). Mean CRF and HRR were 7.7 (SD 2.9) METs and 25 (SD 12) beats/min/min. Both CRF and HRR were associated with the risk of SCD in the entire study population (HRCRF0.47 (0.37-0.59), p<0.001 and HRHRR0.57 (0.48-0.67), p<0.001 with HR estimates corresponding to one SD increase in the exposure variables) and with CRF, HRR and LVEF in the same model (HRCRF0.60 (0.45-0.79), p<0.001, HRHRR0.65 (0.51-0.82), p<0.001) or adjusting additionally for all significant risk factors for SCD (LVEF, sex, creatinine level, history of myocardial infarction and atrial fibrillation, corrected QT interval) (HRCRF0.69 (0.52-0.93), p<0.01, HRHRR0.74 (0.58-0.95) p=0.02). CONCLUSIONS CRF and HRR are significantly associated with the risk of SCD regardless of LVEF.
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Affiliation(s)
- Jussi A Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland .,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Juho T Tynkkynen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Department of Radiology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Pashupati P Mishra
- Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Tuomo Nieminen
- Department of Internal Medicine, Päijät-Häme Central-Hospital, Lahti, Finland
| | - Terho Lehtimaki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiology, Tays Heart Hospital, Tampere University Hopsital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, University of Tampere, Tampere, Finland
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23
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SBP above 180 mmHg at moderate exercise workload increases coronary heart disease risk in healthy men during 28-year follow-up. J Hypertens 2019; 37:949-955. [DOI: 10.1097/hjh.0000000000001959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Weisser B. Exercise Testing in Sports Medicine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:731-732. [PMID: 30518474 PMCID: PMC6293124 DOI: 10.3238/arztebl.2018.0731c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Burkhard Weisser
- *Institut für Sportwissenschaft Sportmedizin Christian-Albrechts-Universität zu Kiel
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25
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Engeseth K, Prestgaard EE, Mariampillai JE, Grundvold I, Liestol K, Kjeldsen SE, Bodegard J, Erikssen JE, Gjesdal K, Skretteberg PT. Physical fitness is a modifiable predictor of early cardiovascular death: A 35-year follow-up study of 2014 healthy middle-aged men. Eur J Prev Cardiol 2018; 25:1655-1663. [DOI: 10.1177/2047487318793459] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Physical fitness has been shown to predict cardiovascular death during long-term follow-up. In the present study we aimed to investigate how physical fitness and other cardiovascular risk factors at middle-age influenced the risk of cardiovascular death during the early (0–11 years), intermediate (12–23 years) and late (24–35 years) parts of a 35-year observation period. Methods and results Age-adjusted physical fitness was calculated in 2014 apparently healthy, middle-aged men after maximal bicycle electrocardiogram-tests in 1972–1975 (Survey 1) and 1979–1982 (Survey 2). The men were assessed through 35 years after Survey 1, and 28 years after Survey 2 by Cox proportional hazards models. Low Survey 1 physical fitness was independently associated with increased risks of early and intermediate, but not late, cardiovascular death. Survey 1 to Survey 2 change in physical fitness, age, smoking status, systolic blood pressure and cholesterol impacted cardiovascular death risks in all periods. Family history of coronary heart disease impacted early and intermediate, but not late, cardiovascular death. Conclusions Most classical cardiovascular risk factors were strong predictors of early, intermediate and late cardiovascular death. Physical fitness measured at median age 50 years was independently associated with risk of early cardiovascular death, but the association weakened as time progressed. Change in physical fitness during middle-age impacted cardiovascular death risk in a full lifetime perspective. Thus, our data suggest that physical fitness is a modifiable cardiovascular risk factor with limited duration in contrast to the sustained impact of smoking, blood pressure and cholesterol on cardiovascular mortality.
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Affiliation(s)
- Kristian Engeseth
- Institute of Clinical Medicine, University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Norway
| | - Erik E Prestgaard
- Institute of Clinical Medicine, University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Norway
| | | | | | - Knut Liestol
- Department of Informatics, University of Oslo, Norway
| | - Sverre E Kjeldsen
- Institute of Clinical Medicine, University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Norway
| | - Johan Bodegard
- Department of Cardiology, Oslo University Hospital, Norway
| | | | - Knut Gjesdal
- Institute of Clinical Medicine, University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Norway
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26
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Höchsmann C, Meister S, Gehrig D, Gordon E, Li Y, Nussbaumer M, Rossmeissl A, Schäfer J, Hanssen H, Schmidt-Trucksäss A. Effect of E-Bike Versus Bike Commuting on Cardiorespiratory Fitness in Overweight Adults: A 4-Week Randomized Pilot Study. Clin J Sport Med 2018; 28:255-265. [PMID: 29095201 DOI: 10.1097/jsm.0000000000000438] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess if active commuting with an electrically assisted bicycle (e-bike) during a 4-week period can induce increases in cardiorespiratory fitness measured as peak oxygen uptake (V[Combining Dot Above]O2peak) in untrained, overweight individuals, and if these changes are comparable with those induced by a conventional bicycle. DESIGN Four-week randomized pilot study. SETTING Controlled laboratory. PARTICIPANTS Thirty-two volunteers (28 men) participated. Seventeen {median age 37 years [interquartile range (IQR) 34, 45], median body mass index [BMI] 29 kg/m [IQR 27, 31]} were randomized to the E-Bike group and 15 [median age 43 years (IQR 38, 45), median BMI 28 kg/m (IQR 26, 29)] to the Bike group. INTERVENTIONS Participants in both groups were instructed to use the bicycle allocated to them (e-bike or conventional bicycle) for an active commute to work in the Basel (Switzerland) area at a self-chosen speed on at least 3 days per week during the 4-week intervention period. MAIN OUTCOME MEASURES V[Combining Dot Above]O2peak was assessed before and after the intervention in an all-out exercise test on a bicycle ergometer. RESULTS V[Combining Dot Above]O2peak increased by an average of 3.6 mL/(kg·min) [SD 3.6 mL/(kg·min)] in the E-Bike group and by 2.2 mL/(kg·min) [SD 3.5 mL/(kg·min)] in the Bike group, with an adjusted difference between the 2 groups of 1.4 mL/(kg·min) [95% confidence interval, -1.4-4.1; P = 0.327]. CONCLUSIONS E-bikes may have the potential to improve cardiorespiratory fitness similar to conventional bicycles despite the available power assist, as they enable higher biking speeds and greater elevation gain.
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Affiliation(s)
- Christoph Höchsmann
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Steffen Meister
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Damiana Gehrig
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Elisa Gordon
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yanlei Li
- Center of Medical Physics and Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Monique Nussbaumer
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Anja Rossmeissl
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Juliane Schäfer
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Henner Hanssen
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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27
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Kato Y, Suzuki S, Uejima T, Semba H, Yamashita T. Variable prognostic value of blood pressure response to exercise. J Cardiol 2018; 71:31-35. [DOI: 10.1016/j.jjcc.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/18/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
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28
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Prestgaard E, Hodnesdal C, Engeseth K, Erikssen J, Bodegård J, Liestøl K, Gjesdal K, Kjeldsen SE, Grundvold I, Berge E. Long-term predictors of stroke in healthy middle-aged men. Int J Stroke 2017; 13:292-300. [DOI: 10.1177/1747493017730760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There are few data on risk factors for stroke during long-term follow-up of healthy individuals. Aims We aimed to investigate the long-term predictive impact on stroke risk of baseline variables including hemodynamic variables measured at rest and during exercise in middle-aged, healthy men. Methods We performed a prospective cohort study of 2014 healthy Norwegian men aged 40–59 years, recruited during the period 1972–1975 and followed until 2007. Participants underwent a comprehensive clinical assessment at baseline, including a bicycle exercise test. Data on stroke, transient ischemic attack, and death were collected on all participants from follow-up visits, medical records, and the National Cause of Death Registry. We used Cox regression for analysis and estimated hazard ratios with 95% confidence intervals, adjusting for traditional risk factors and hemodynamic variables measured at rest and during exercise. Results During 35 years’ follow-up, 316 participants (16%) had stroke, of which 287 (91%) were ischemic and 29 (9%) were hemorrhagic. Age (hazard ratio 2.70 per increase in one standard deviation, 95% confidence interval 2.13–3.43), resting systolic blood pressure (hazard ratio 1.24, 95% confidence interval 1.11–1.39), body mass index (hazard ratio 1.14, 95% confidence interval 1.02–1.29), and atrioventricular conduction time (hazard ratio 1.11, 95% confidence interval 1.03–1.19) were significantly associated with long-term risk of stroke, as were maximal systolic blood pressure and heart rate during exercise (hazard ratio 1.28, 95% confidence interval 1.13–1.46, and hazard ratio 0.86, 95% confidence interval 0.74–0.99, respectively). Conclusions Hemodynamic variables at rest and during exercise testing add to the predictive value of clinical variables in healthy, middle-aged men, and should be included in the assessment of long-term risk of stroke, when available.
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Affiliation(s)
- Erik Prestgaard
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | | | - Kristian Engeseth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - Jan Erikssen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johan Bodegård
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Knut Gjesdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - Sverre E. Kjeldsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - Irene Grundvold
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
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29
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Keller K, Stelzer K, Ostad MA, Post F. Impact of exaggerated blood pressure response in normotensive individuals on future hypertension and prognosis: Systematic review according to PRISMA guideline. Adv Med Sci 2017; 62:317-329. [PMID: 28511070 DOI: 10.1016/j.advms.2016.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/09/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Arterial hypertension (aHT) is the leading risk factor for morbidity and mortality worldwide. Blood pressure (BP) deviation at rest is well defined and accompanies risk for cardiovascular events and cardiovascular mortality. A growing body of evidence emphasises that an exaggerated blood pressure response (EBPR) in cardiopulmonary exercise testing (CPET) could help to identify seemingly cardiovascular healthy and normotensive subjects, who have an increased risk of developing aHT and cardiovascular events in the future. MATERIALS AND METHODS The PubMed online database was searched for published studies reporting exercise-related BP and both the risk of aHT and cardiovascular events in the future. RESULTS We identified 18 original studies about EBPR in CPET, which included a total of 35,151 normotensive individuals for prediction of new onset of aHT in the future and 11 original studies with 43,012 enrolled subjects with the endpoint of cardiovascular events in the future. Although an EBPR under CPET is not well defined, a large number of studies emphasise that EBPR in CPET is associated with both new-onset aHT and cardiovascular events in the future. CONCLUSIONS A growing number of studies support the hypothesis that EBPR in CPET may be a diagnostic tool to identify subjects with an elevated risk of developing aHT and cardiovascular events in the future.
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30
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Absence of resting cardiovascular dysfunction in middle-aged endurance-trained athletes with exaggerated exercise blood pressure responses. J Hypertens 2017; 35:1586-1593. [DOI: 10.1097/hjh.0000000000001365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Mariampillai JE, Engeseth K, Kjeldsen SE, Grundvold I, Liestøl K, Erikssen G, Erikssen J, Bodegard J, Skretteberg PT. Exercise systolic blood pressure at moderate workload predicts cardiovascular disease and mortality through 35 years of follow-up in healthy, middle-aged men. Blood Press 2017; 26:229-236. [DOI: 10.1080/08037051.2017.1291276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Kristian Engeseth
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Sverre E. Kjeldsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Irene Grundvold
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- The Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Gunnar Erikssen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan Erikssen
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johan Bodegard
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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32
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Bouzas-Mosquera C, Bouzas-Mosquera A, Peteiro J. Valor pronóstico del incremento de la presión arterial sistólica con el ejercicio en pacientes hipertensos con enfermedad coronaria conocida o sospechada. Med Clin (Barc) 2017; 148:51-56. [DOI: 10.1016/j.medcli.2016.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
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33
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Engeseth K, Hodnesdal C, Grundvold I, Liestøl K, Gjesdal K, Kjeldsen SE, Erikssen JE, Bodegard J, Skretteberg PT. Temporal Reduction in Chronotropic Index Predicts Risk of Cardiovascular Death Among Healthy Middle-Aged Men: a 28-Year Follow-Up Study. J Am Heart Assoc 2016; 5:e004555. [PMID: 27881424 PMCID: PMC5210440 DOI: 10.1161/jaha.116.004555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronotropic index is a standardized measure of heart rate (HR) increment during exercise that reflects the combined effects of age, resting HR, and physical fitness. Low chronotropic index has been reported to predict disease and death. We tested whether temporal change in chronotropic index over 7 years influenced risk of cardiovascular death through up to 28 years. METHODS AND RESULTS Chronotropic index was calculated ([achieved maximal HR-resting HR]/[age-predicted maximal HR-resting HR]) after a symptom-limited bicycle ECG exercise test in 1420 healthy men at 2 examinations 7 years apart, in 1972 and 1979. Events of cardiovascular death were registered by manual scrutiny of all participants' hospital charts and the Norwegian Cause of Death Registry. The participants were divided into quartiles of temporal change in chronotropic index, with quartile one having the most negative value. Cox proportional hazard regression models were used to estimate risks and adjusted for classical cardiovascular risk factors. Incidence of cardiovascular death was 310 (22%) during median of 21 years of follow-up. After multivariable adjustment, and comparison with quartile four (mean +0.11), quartiles one (-0.16), two (-0.04), and three (+0.02) were associated with hazard ratios 1.50 (95% CI 1.10-2.05), 1.10 (0.79-1.53), and 1.04 (0.74-1.45) for cardiovascular death. Results remained robust also after exclusion of 31 participants with exercise ECG-induced signs of coronary ischemia. CONCLUSIONS Temporal reduction in chronotropic index was associated with increased long-term risk of cardiovascular death and might be a clinically important predictor when assessing risk in healthy individuals over a longer time.
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Affiliation(s)
- Kristian Engeseth
- Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Christian Hodnesdal
- Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Irene Grundvold
- Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Centre for Clinical Heart Research, Oslo University Hospital, Oslo, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Norway
| | - Knut Gjesdal
- Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Sverre E Kjeldsen
- Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | | | - Johan Bodegard
- Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
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34
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Spranger MD, Kaur J, Sala-Mercado JA, Krishnan AC, Abu-Hamdah R, Alvarez A, Machado TM, Augustyniak RA, O'Leary DS. Exaggerated coronary vasoconstriction limits muscle metaboreflex-induced increases in ventricular performance in hypertension. Am J Physiol Heart Circ Physiol 2016; 312:H68-H79. [PMID: 27769997 DOI: 10.1152/ajpheart.00417.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 02/07/2023]
Abstract
Increases in myocardial oxygen consumption during exercise mainly occur via increases in coronary blood flow (CBF) as cardiac oxygen extraction is high even at rest. However, sympathetic coronary constrictor tone can limit increases in CBF. Increased sympathetic nerve activity (SNA) during exercise likely occurs via the action of and interaction among activation of skeletal muscle afferents, central command, and resetting of the arterial baroreflex. As SNA is heightened even at rest in subjects with hypertension (HTN), we tested whether HTN causes exaggerated coronary vasoconstriction in canines during mild treadmill exercise with muscle metaboreflex activation (MMA; elicited by reducing hindlimb blood flow by ~60%) thereby limiting increases in CBF and ventricular performance. Experiments were repeated after α1-adrenergic blockade (prazosin; 75 µg/kg) and in the same animals following induction of HTN (modified Goldblatt 2K1C model). HTN increased mean arterial pressure from 97.1 ± 2.6 to 132.1 ± 5.6 mmHg at rest and MMA-induced increases in CBF, left ventricular dP/dtmax, and cardiac output were markedly reduced to only 32 ± 13, 26 ± 11, and 28 ± 12% of the changes observed in control. In HTN, α1-adrenergic blockade restored the coronary vasodilation and increased in ventricular function to the levels observed when normotensive. We conclude that exaggerated MMA-induced increases in SNA functionally vasoconstrict the coronary vasculature impairing increases in CBF, which limits oxygen delivery and ventricular performance in HTN. NEW & NOTEWORTHY We found that metaboreflex-induced increases in coronary blood flow and ventricular contractility are attenuated in hypertension. α1-Adrenergic blockade restored these parameters toward normal levels. These findings indicate that the primary mechanism mediating impaired metaboreflex-induced increases in ventricular function in hypertension is accentuated coronary vasoconstriction.
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Affiliation(s)
- Marty D Spranger
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Jasdeep Kaur
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Javier A Sala-Mercado
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Abhinav C Krishnan
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Rania Abu-Hamdah
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Alberto Alvarez
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Tiago M Machado
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Robert A Augustyniak
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Donal S O'Leary
- Department of Physiology and Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan
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Bouzas-Mosquera MC, Bouzas-Mosquera A, Peteiro J. Excessive blood pressure increase with exercise and risk of all-cause mortality and cardiac events. Eur J Clin Invest 2016; 46:833-9. [PMID: 27505135 DOI: 10.1111/eci.12665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The association of an excessive blood pressure increase with exercise (EBPIE) on cardiovascular outcomes remains controversial. We sought to assess its impact on the risk of all-cause mortality and major cardiac events in patients with known or suspected coronary artery disease (CAD) referred for stress testing. MATERIALS AND METHODS Exercise echocardiography was performed in 10 047 patients with known or suspected CAD. An EBPIE was defined as an increase in systolic blood pressure with exercise ≥ 80 mmHg. The endpoints were all-cause mortality and major cardiac events (MACE), including cardiac death or nonfatal myocardial infarction (MI). RESULTS Overall, 573 patients exhibited an EBPIE during the tests. Over a mean follow-up of 4·8 years, there were 1950 deaths (including 725 cardiac deaths), 1477 MI and 1900 MACE. The cumulative 10-year rates of all-cause mortality, cardiac death, nonfatal MI and MACE were 32·9%, 13·1%, 26·9% and 33% in patients who did not develop an EBPIE vs. 18·9%, 4·7%, 17·5% and 20·7% in those experiencing an EBPIE, respectively (P < 0·001 for all comparisons). In Cox regression analyses, an EBPIE remained predictive of all-cause mortality (hazard ratio [HR] 0·73, 95% confidence interval [CI] 0·59-0·91, P = 0·004), cardiac death (HR 0·67, 95% CI 0·46-0·98, P = 0·04), MI (HR 0·67, 95% CI 0·52-0·86, P = 0·002) and MACE (HR 0·69, 95% CI 0·56-0·86, P = 0·001). CONCLUSIONS An EBPIE was associated with a significantly lower risk of mortality and MACE in patients with known or suspected CAD referred for stress testing.
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Affiliation(s)
| | | | - Jesús Peteiro
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
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Older age is associated with greater central aortic blood pressure following the exercise stress test in subjects with similar brachial systolic blood pressure. Heart Vessels 2016; 31:1354-60. [DOI: 10.1007/s00380-015-0733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
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Laurinavicius AG, Bittencourt MS, Blaha MJ, Nary FC, Kashiwagi NM, Conceiçao RD, Meneghelo RS, Prado RR, Carvalho JAM, Nasir K, Blumenthal RS, Santos RD. Association between non-alcoholic hepatic steatosis and hyper reactive blood pressure response on the exercise treadmill test. QJM 2016; 109:531-7. [PMID: 26792853 PMCID: PMC4986427 DOI: 10.1093/qjmed/hcw003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Indexed: 12/28/2022] Open
Abstract
AIMS Non-alcoholic hepatic steatosis (HS) is associated with hypertension and increased cardiovascular risk. While Blood pressure hyper-reactive response (HRR) during peak exercise indicates an increased risk of incident hypertension and increased cardiovascular risk, no data on the association of non-alcoholic HS and HRR exists. In this study, we have evaluated the association of HS with HRR. METHODS We included 13 410 consecutive individuals with a mean age: 42.4 ± 8.9 years, 3561 (26.6%) female with normal resting blood pressure and without a previous diagnosis of hypertension, who underwent symptom limited exercise treadmill test, abdominal ultrasonography and clinical and laboratory evaluation. HS was detected by abdominal ultrasonography. HRR was defined by a peak exercise systolic blood pressure >220 mmHg and/or elevation of 15 mmHg or more in diastolic blood pressure from rest to peak exercise. RESULTS The prevalence of HS was 29.5% (n = 3956). Overall, 4.6% (n = 619) of the study population presented a HRR. Subjects with HS had a higher prevalence of HRR (8.1 vs. 3.1%, odds ratio 2.8, 95% CI 2.4-3.3, P < 0.001). After adjustment for body mass index, waist circumference, fasting plasma glucose and low density lipoprotein cholesterol, HS (odds ratio 1.4, 95% CI 1.1-1.6, P = 0.002) remained independently associated with HRR. HS was additive to obesity markers in predicting exercise HRR. CONCLUSIONS Non-alcoholic HS is independently associated with hyper-reactive exercise blood pressure response.
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Affiliation(s)
- A G Laurinavicius
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil, Lipid Clinic Heart Institute (InCor) University of Sao Paulo, Medical School Hospital, Av. Eneas de Carvalho Aguiar, 44, CEP-05403-900, Säo Paulo, Brazil
| | - M S Bittencourt
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil, Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Av. Lineu Prestes, 2565, CEP-05508-000, Säo Paulo, Brazil
| | - M J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 601 North Caroline Street,Suite 7200, Baltimore, MD 21287, USA and
| | - F C Nary
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil
| | - N M Kashiwagi
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil
| | - R D Conceiçao
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil
| | - R S Meneghelo
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil
| | - R R Prado
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil
| | - J A M Carvalho
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil
| | - K Nasir
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 601 North Caroline Street,Suite 7200, Baltimore, MD 21287, USA and Preventive Cardiology and Wellness Center, Baptist Hospital, 1691 Michigan Ave Suite 500, Miami Beach, FL 33139, United States
| | - R S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, 601 North Caroline Street,Suite 7200, Baltimore, MD 21287, USA and
| | - R D Santos
- From the Preventive Medicine Center Hospital Israelita Albert Einstein, Av. Brasil, 953, CEP-01431-000, Säo Paulo, Brazil, Lipid Clinic Heart Institute (InCor) University of Sao Paulo, Medical School Hospital, Av. Eneas de Carvalho Aguiar, 44, CEP-05403-900, Säo Paulo, Brazil,
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Hacke C, Weisser B. Reference Values for Exercise Systolic Blood Pressure in 12- to 17-Year-Old Adolescents. Am J Hypertens 2016; 29:747-53. [PMID: 26563964 DOI: 10.1093/ajh/hpv178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In adults, blood pressure (BP) during exercise has prognostic advantages compared to resting BP, whereas its relevance for children has not been revealed as clearly. Because exercise BP among young subjects might be of clinical importance, we sought to determine reference values in adolescents. METHODS BP recordings at rest and during a cycle ergometer test (1.5W/kg) were assessed in 492 teenagers (12-17 years) in the Kiel EX.PRESS. Study (EXercise and PRESSure). The resting systolic BP (SBP) values at the 90th and 95th percentile of the German reference population were applied on our resting SBP distribution. The resulting resting SBP percentiles were then used to propose exercise SBP limits. RESULTS Of our group, 12.4% exhibited a resting SBP ≥ 90th reference percentile, with 7.9% ≥ 95th percentile. The corresponding age group- and sex-specific percentiles were assigned to the exercise SBP distribution resulting in reference values for high normal and elevated SBP (upper limit, girls/boys, mm Hg): 172/172 for 12-13 years, 174.7/177.3 for 14-15 years, 178.5/201.3 for 16-17 years). Using these limits, exercise SBP values were elevated in 8.1%, 5.5% were within the high normal range. Normal resting SBP but at least high normal exercise SBP was found in 7.7%. In contrast, 7.4% were high normal or hypertensive at rest but normotensive during exercise. CONCLUSIONS Exercise BP is expected to be of additional use for the evaluation of BP in younger age groups. As long as prognostic data for exercise BP in adolescents are not available, the limits proposed might be considered in clinical practice.
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Affiliation(s)
- Claudia Hacke
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University of Kiel, Kiel, Germany; Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Kiel, Germany.
| | - Burkhard Weisser
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University of Kiel, Kiel, Germany
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Spartano NL, Lyass A, Larson MG, Lewis GD, Vasan RS. Submaximal Exercise Systolic Blood Pressure and Heart Rate at 20 Years of Follow-up: Correlates in the Framingham Heart Study. J Am Heart Assoc 2016; 5:e002821. [PMID: 27233297 PMCID: PMC4937245 DOI: 10.1161/jaha.115.002821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Beyond their resting values, exercise responses in blood pressure (BP) and heart rate (HR) may add prognostic information for cardiovascular disease (CVD). In cross-sectional studies, exercise BP and HR responses correlate with CVD risk factors; however, it is unclear which factors influence longitudinal changes in exercise responses over time, which is important for our understanding of the development of CVD. METHODS AND RESULTS We assessed BP and HR responses to low-level exercise tests (6-minute Bruce protocol) in 1231 Framingham Offspring participants (55% women) who underwent a routine treadmill test in 1979-1983 (baseline; mean age 39±8 years) that was repeated in 1998-2001 (follow-up; mean age 58±8 years). Adjusting for baseline exercise responses, we related the follow-up exercise responses to baseline CVD risk factors and to their changes between examinations. Compared with men, women had greater rise in exercise systolic (S)BP and HR at 20-year follow-up (both P<0.005). Baseline blood lipid levels, resting SBP and HR, and smoking status were associated with greater exercise SBP at follow-up (all P<0.05). Weight gain across examinations was associated with higher exercise SBP and HR at follow-up (both P<0.0001). Smoking cessation was associated with a 53% reduced risk of attaining the highest quartile of exercise SBP (≥180 mm Hg) at follow-up (P<0.05). CONCLUSION An adverse CVD risk factor profile in young adults and its worsening over time were associated with higher SBP and HR responses to low-level exercise in midlife. Maintaining or adopting a healthy risk factor profile may favorably impact the exercise responses over time.
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Affiliation(s)
- Nicole L Spartano
- Sections of Preventative Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Asya Lyass
- Framingham Heart Study, Framingham, MA Department of Mathematics and Statistics, Boston University, Boston, MA
| | - Martin G Larson
- Framingham Heart Study, Framingham, MA Department of Mathematics and Statistics, Boston University, Boston, MA Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Gregory D Lewis
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ramachandran S Vasan
- Sections of Preventative Medicine and Epidemiology, and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA Framingham Heart Study, Framingham, MA Department of Epidemiology, Boston University School of Public Health, Boston, MA
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Williamson W, Boardman H, Lewandowski AJ, Leeson P. Time to rethink physical activity advice and blood pressure: A role for occupation-based interventions? Eur J Prev Cardiol 2016; 23:1051-3. [PMID: 27118364 DOI: 10.1177/2047487316645008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wilby Williamson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Adam James Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Assessing cutoff values for increased exercise blood pressure to predict incident hypertension in a general population. J Hypertens 2016; 33:1386-93. [PMID: 25807218 DOI: 10.1097/hjh.0000000000000568] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Cutoff values for increased exercise blood pressure (BP) are not established in hypertension guidelines. The aim of the study was to assess optimal cutoff values for increased exercise BP to predict incident hypertension. METHODS Data of 661 normotensive participants (386 women) aged 25-77 years from the Study of Health in Pomerania (SHIP-1) with a 5-year follow-up were used. Exercise BP was measured at a submaximal level of 100 W and at maximum level of a symptom-limited cycle ergometry test. Cutoff values for increased exercise BP were defined at the maximum sum of sensitivity and specificity for the prediction of incident hypertension. The area under the receiver-operating characteristic curve (AUC) and net reclassification index (NRI) were calculated to investigate whether increased exercise BP adds predictive value for incident hypertension beyond established cardiovascular risk factors. RESULTS In men, values of 160 mmHg (100 W level; AUC = 0.7837; NRI = 0.534, P < 0.001) and 210 mmHg (maximum level; AUC = 0.7677; NRI = 0.340, P = 0.003) were detected as optimal cutoff values for the definition of increased exercise SBP. A value of 190 mmHg (AUC = 0.8347; NRI = 0.519, P < 0.001) showed relevance for the definition of increased exercise SBP in women at the maximum level. CONCLUSION According to our analyses, 190 and 210 mmHg are clinically relevant cutoff values for increased exercise SBP at the maximum exercise level of cycle ergometry test for women and men, respectively. In addition, for men, our analyses provided a cutoff value of 160 mmHg for increased exercise SBP at the 100 W level.
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Renal denervation improves exercise blood pressure: insights from a randomized, sham-controlled trial. Clin Res Cardiol 2016; 105:592-600. [PMID: 26728060 DOI: 10.1007/s00392-015-0955-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/18/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite the ongoing debate on the role of renal sympathetic denervation (RSD) in the management of therapy-resistant hypertension, little is known about its possible effects on exercise blood pressure (BP), a known predictor for future cardiovascular events. We sought to evaluate the effect of RSD on exercise BP in a randomized, sham-controlled trial in patients with mild hypertension. METHODS AND RESULTS Patients with therapy-resistant mild hypertension (defined by mean daytime systolic BP between 135 and 149 mmHg or mean daytime diastolic BP between 90 and 94 mmHg on 24-h ambulatory BP measurement) were randomized to either radiofrequency-based RSD or a sham procedure. Patients underwent cardiopulmonary exercise testing at baseline and after 6 months. Of the 71 patients randomized, data from cardiopulmonary exercise testing were available for 48 patients (22 in the RSD group, 26 in the sham group). After 6 months, patients undergoing RSD had a significantly lower systolic BP at maximum exercise workload compared to baseline (-14.2 ± 26.1 mmHg, p = 0.009). In contrast, no change was observed in the sham group (0.6 ± 22.9 mmHg, p = 0.45, p = 0.04 for between-group comparison). When analyzing patients with exaggerated baseline exercise BP only, the effect was even more pronounced (RSD vs. sham -29.5 ± 23.4 vs. 0.1 ± 25.3 mmHg, p = 0.008). CONCLUSION Exercise systolic BP values in patients with mild therapy-resistant hypertension are reduced after RSD as compared to a sham-procedure.
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Bouzas-Mosquera MC, Bouzas-Mosquera A, Peteiro J. Association Between an Exaggerated Exercise Blood Pressure Response and Mortality and Cardiovascular Events in Older Adults with Known or Suspected Coronary Artery Disease. J Am Geriatr Soc 2015; 63:2635-2637. [PMID: 26691707 DOI: 10.1111/jgs.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Jesús Peteiro
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
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Tzemos N, Lim PO, Mackenzie IS, MacDonald TM. Exaggerated Exercise Blood Pressure Response and Future Cardiovascular Disease. J Clin Hypertens (Greenwich) 2015; 17:837-44. [PMID: 26235814 PMCID: PMC8032021 DOI: 10.1111/jch.12629] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/08/2015] [Accepted: 05/12/2015] [Indexed: 01/03/2024]
Abstract
Exaggerated blood pressure (BP) response to exercise predicts future hypertension. However, there is considerable lack of understanding regarding the mechanism of how this abnormal response is generated, and how it relates to the future establishment of cardiovascular disease. The authors studied 82 healthy male volunteers without cardiovascular risk factors. The participants were categorized into two age-matched groups depending on their exercise systolic BP (ExSBP) rise after 3 minutes of exercise using a submaximal step test: exaggerated ExSBP group (hyper-responders [peak SBP ≥ 180 mm Hg]) and low ExSBP responder group (hypo-responders [peak SBP <180 mm Hg]). Forearm venous occlusion plethysmography and intra-arterial infusions of acetylcholine (ACh), N(G)-monomethyl-L-arginine (L-NMMA), sodium nitroprusside (SNP), and norepinephrine (NE) were used to assess vascular reactivity. Proximal aortic compliance was assessed with ultrasound, and neurohormonal blood sampling was performed at rest and during peak exercise. The hyper-responder group exhibited a significantly lower increase in forearm blood flow (FBF) with ACh compared with the hypo-responder group (ΔFBF 215% [14] vs 332.3% [28], mean [standard error of the mean]; P<.001), as well as decreased proximal aortic compliance. The vasoconstrictive response to L-NMMA was significantly impaired in the hyper-responder group in comparison to the hypo-responder group (ΔFBF -40.2% [1.6] vs -50.2% [2.6]; P<.05). In contrast, the vascular response to SNP and NE were comparable in both groups. Peak exercise plasma angiotensin II levels were significantly higher in the hyper-responder group (31 [1] vs 23 [2] pg/mL, P=.01). An exaggerated BP response to exercise is related to endothelial dysfunction, decreased proximal aortic compliance, and increased exercise-related neurohormonal activation, the constellation of which may explain future cardiovascular disease.
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Affiliation(s)
- Nikolaos Tzemos
- Institute of Cardiovascular and Medical SciencesBritish Heart FoundationGlasgow Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Pitt O. Lim
- Hypertension Research CentreMedical Research InstituteNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - Isla S. Mackenzie
- Hypertension Research CentreMedical Research InstituteNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - Thomas M. MacDonald
- Hypertension Research CentreMedical Research InstituteNinewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
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Michishita R, Ohta M, Ikeda M, Jiang Y, Yamato H. [Associations of the work duration, sleep duration and number of holidays with an exaggerated blood pressure response during an exercise stress test among workers]. SANGYŌ EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2015; 58:11-20. [PMID: 26497611 DOI: 10.1539/sangyoeisei.b15021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM It has been reported that an exaggerated systolic blood pressure (ESBP) response during exercise, even if resting blood pressure is normal, is associated with an increased risk of future hypertension and cardiovascular disease (CVD). This study was designed to investigate the relationships of work duration, sleep duration and number of holidays with blood pressure response during an exercise stress test among normotensive workers. SUBJECTS AND METHODS The subjects were 362 normotensive workers (79 males and 283 females; age, 49.1 years). A multi-stage graded submaximal exercise stress test was performed on each subject using an electric bicycle ergometer. The workload was increased every 3 minutes, and blood pressure was measured at rest and during the last 1 minute of each stage. In this study, an ESBP response during exercise was defined according to the criteria of the Framingham Study (peak systolic blood pressure ≥210 mmHg in males, or ≥190 mmHg in females). Working environments, work duration, sleep duration, number of holidays, and physical activity during commuting and work, and leisure time exercise duration were evaluated using a questionnaire. RESULTS An ESBP response during exercise was observed in 94 (26.0%) workers. The adjusted odds ratio for the prevalence of an ESBP response during exercise was found to be significantly higher with an increase in work duration, decreases in sleep duration and number of holidays (p<0.05, respectively). Moreover, the highest work duration with lowest sleep duration and number of holidays groups had significantly higher adjusted odds ratio for the prevalence of an ESBP response during exercise than the lowest work duration with highest sleep duration and number of holidays groups (p<0.05, respectively). CONCLUSIONS Based on our results, we consider that the assessment of blood pressure response during exercise and daily life are necessary to prevent the incidence of future hypertension, CVD and death due to overwork in workers with long-work duration, short sleep duration and small number of holidays.
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Affiliation(s)
- Ryoma Michishita
- Department of Health Development, Institute of Industrial Ecological Science, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
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Abiodun OO, Balogun MO, Akintomide AO, Adebayo RA, Ajayi OE, Ogunyemi SA, Amadi VN, Adeyeye VO. Comparison between treadmill and bicycle ergometer exercise tests in mild-to-moderate hypertensive Nigerians. Integr Blood Press Control 2015; 8:51-5. [PMID: 26316811 PMCID: PMC4540160 DOI: 10.2147/ibpc.s75888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Comparative cardiovascular responses to treadmill and bicycle ergometer (bike) exercise tests in hypertensive Nigerians are not known. This study compared cardiovascular responses to the two modes of exercise testing in hypertensives using maximal exercise protocols. METHODS One hundred and ten male subjects with mild-to-moderate hypertension underwent maximal treadmill and bike test one after the other at a single visit in a simple random manner. Paired-sampled t-test was used to compare responses to both exercise tests while chi-squared test was used to compare categorical variables. RESULTS The maximal heart rate (P<0.001), peak systolic blood pressure (P=0.02), rate pressure product (P<0.001), peak oxygen uptake (P<0.001), and exercise capacity (P<0.001) in metabolic equivalents were signifcantly higher on the treadmill than on the bike. CONCLUSION Higher cardiovascular responses on treadmill in Nigerian male hypertensives in this study, similar to findings in non-hypertensives and non-Nigerians in earlier studies, suggest that treadmill may be of better diagnostic utility in our population.
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Affiliation(s)
- Olugbenga O Abiodun
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Il-Ife, Osun state, Nigeria
| | - Michael O Balogun
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Il-Ife, Osun state, Nigeria
| | - Anthony O Akintomide
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Il-Ife, Osun state, Nigeria
| | - Rasaaq A Adebayo
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Il-Ife, Osun state, Nigeria
| | - Olufemi E Ajayi
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Il-Ife, Osun state, Nigeria
| | - Suraj A Ogunyemi
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Il-Ife, Osun state, Nigeria
| | - Valentine N Amadi
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Il-Ife, Osun state, Nigeria
| | - Victor O Adeyeye
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Il-Ife, Osun state, Nigeria
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Rontoyanni VG, Werner K, Sanders TAB, Hall WL. Differential acute effects of carbohydrate- and protein-rich drinks compared with water on cardiac output during rest and exercise in healthy young men. Appl Physiol Nutr Metab 2015; 40:803-10. [PMID: 26244599 DOI: 10.1139/apnm-2014-0358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The acute effects of drinks rich in protein (PRO) versus carbohydrate (CHO) on cardiovascular hemodynamics and reactivity are uncertain. A randomized crossover design was used to compare 400-mL isoenergetic (1.1 MJ) drinks containing whey protein (PRO; 44 g) or carbohydrate (CHO; 57 g) versus 400 mL of water in 14 healthy men. The primary and secondary outcomes were changes in cardiac output, blood pressure, systemic vascular resistance (SVR) and digital volume pulse measured prior to and 30 min following consumption at rest, during 12 min of multi-stage bicycle ergometry, and 15 min postexercise. The mean change (95% confidence interval (CI)) in resting cardiac output at 30 min was greater for CHO than for PRO or water: 0.7 (0.4 to 1.0), 0.1 (-0.2 to 0.40), and 0.0 (-0.3 to 0.3) L/min (P < 0.001), respectively; the higher cardiac output following CHO was accompanied by an increase in stroke volume and a lower SVR. The mean increments (95% CI) in cardiac output during exercise were CHO 4.7 (4.4 to 5.0), PRO 4.9 (4.6 to 5.2), and water 4.6 (4.3 to 4.9) L/min with the difference between PRO versus water being significant (P < 0.025). There were no other statistically significant differences. In summary, a CHO-rich drink increased cardiac output and lowered SVR in the resting state compared with a PRO-rich drink or water but the effect size of changes in these variables did not differ during or after exercise between CHO and PRO. Neither protein nor carbohydrate affected blood pressure reactivity to exercise.
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Affiliation(s)
- Victoria G Rontoyanni
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.,Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Kristin Werner
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.,Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Thomas A B Sanders
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.,Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Wendy L Hall
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.,Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
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Abstract
Background In adults, exercise blood pressure seems to be more closely related to cardiovascular risk than resting blood pressure; however, few data are available on the effects of familial risk factors, including smoking habits, on exercise blood pressure in adolescents. Methods and Results Blood pressure at rest and during exercise, parental smoking, and other familial risk factors were investigated in 532 adolescents aged 12 to 17 years (14.6±1.5 years) in the Kiel EX.PRESS. (EXercise PRESSure) Study. Exercise blood pressure was determined at 1.5 W/kg body weight using a standardized submaximal cycle ergometer test. Mean resting blood pressure was 113.1±12.8/57.2±7.1 mm Hg, and exercise blood pressure was 149.9±19.8/54.2±8.6 mm Hg. Parental smoking increased exercise systolic blood pressure (+4.0 mm Hg, 3.1 to 4.9; P=0.03) but not resting blood pressure of the subjects (adjusted for age, sex, height, body mass index percentile, fitness). Parental overweight and familial hypertension were related to both higher resting and exercise systolic blood pressure values, whereas associations with an inactive lifestyle and a low educational level of the parents were found only with adolescents’ blood pressure during exercise. The cumulative effect of familial risk factors on exercise systolic blood pressure was more pronounced than on blood pressure at rest. Conclusions Parental smoking might be a novel risk factor for higher blood pressure, especially during exercise. In addition, systolic blood pressure during a submaximal exercise test was more closely associated with familial risk factors than was resting blood pressure, even in adolescents.
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Affiliation(s)
- Claudia Hacke
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University of Kiel, Germany (C.H., B.W.) Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany (C.H.)
| | - Burkhard Weisser
- Department of Sports Medicine, Institute of Sports Science, Christian-Albrechts-University of Kiel, Germany (C.H., B.W.)
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