Older Women with Controlled Isolated Systolic Hypertension: Exercise and Blood Pressure

Priorities in tackling noncommunicable diseases among the population aged 60 years and older in China, 1990-2021: A population-based study

OBJECTIVE

In China, it is expected that every one in three people will be aged 60 years and above in 2040, surpassing other low- and middle-income countries. The noncommunicable disease (NCD) burden and trends among elderly people must be clarified.

METHODS

In this trend analysis based on the Global Burden of Diseases Study 2021, we reported NCDs per 100,000 people and average annual percentage changes (AAPCs) in disability-adjusted life-years (DALYs), mortality, and incidence at three levels of the GBD 2021 hierarchy by age subgroups and by sex in the older population aged 60 years and above in China during 1990-2021.

RESULTS

In 2021, there were 382 million incident cases of NCDs among elderly individuals in China, leading to 201 million DALYs and 9 million deaths in the same year. During 1990-2021, although cardiovascular diseases substantially reduced both DALYs (-1.2 %/year) and mortality (-1.08 %/year), cardiovascular diseases still accounted for the greatest percentage of DALYs (31000 per 100,000 population [95 % UI 26071-35908]) and mortality (2025 [1678-2355]) in 2021. During 1990-2021, while the total incidence of NCDs decreased (-0.01 %/year), the incidence of mental disorders (0.68 %/year) rapidly increased. Among all level 3 causes, depressive disorder caused the greatest increases in DALYs (0.74%/year), while chronic respiratory diseases showed the most rapid decreases in both DALYs (-3.6 %/year) and mortality (-3.6 %/year). The priorities of NCD control in each age subgroup and sex among elderly individuals varied. In 2021, males had a greater DALY rate from NCDs per 100,000 people than females did (96409 [95 % UI 80625-112283] vs. 67112 [56878-77547]), but females had a greater incidence rate of NCDs than males did (150276 [139285-163373]) vs. 137571 [127439-148789]). High systolic blood pressure had surpassed household air pollution from solid fuels as the leading risk factor for DALYs among the elderly, and it continued to be the top risk factor for mortality in this population.

CONCLUSIONS

The total NCD burden among elderly people in China has been decreasing and changing. Substantial reductions in cardiovascular diseases and chronic respiratory disease have been observed, while rapid increases in mental disorders has also been found. Policies need to be updated to reflect the changing risk landscape. Target interventions should consider age subgroups and sex differences among this population.

L-Citrulline supplementation attenuates aortic pressure and pressure waves during metaboreflex activation in postmenopausal women

Postmenopausal women have augmented pressure wave responses to low-intensity isometric handgrip exercise (IHG) due to an overactive metaboreflex (postexercise muscle ischaemia, PEMI), contributing to increased aortic systolic blood pressure (SBP). Menopause-associated endothelial dysfunction via arginine (ARG) and nitric oxide deficiency may contribute to exaggerated exercise SBP responses. L-Citrulline supplementation (CIT) is an ARG precursor that decreases SBP, pulse pressure (PP) and pressure wave responses to cold exposure in older adults. We investigated the effects of CIT on aortic SBP, PP, and pressure of forward (Pf) and backward (Pb) waves during IHG and PEMI in twenty-two postmenopausal women. Participants were randomised to CIT (10 g/d) or placebo (PL) for 4 weeks. Aortic haemodynamics were assessed via applanation tonometry at rest, 2 min of IHG at 30 % of maximal strength, and 3 min of PEMI. Responses were analysed as change (Δ) from rest to IHG and PEMI at 0 and 4 weeks. CIT attenuated ΔSBP (−9 ± 2 v. −1 ± 1 mmHg, P = 0·006), ΔPP (−5 ± 2 v. 0 ± 1 mmHg, P = 0·03), ΔPf (−6 ± 2 v. −1 ± 1 mmHg, P = 0·01) and ΔPb (−3 ± 1 v. 0 ± 1 mmHg, P = 0·02) responses to PEMI v. PL. The ΔPP during PEMI was correlated with ΔPf (r = 0·743, P < 0·001) and ΔPb (r = 0·724, P < 0·001). Citrulline supplementation attenuates the increase in aortic pulsatile load induced by muscle metaboreflex activation via reductions in forward and backward pressure wave amplitudes in postmenopausal women.

Global burden of disease attributable to high systolic blood pressure in older adults, 1990-2019: an analysis for the Global Burden of Disease Study 2019

AIMS

High systolic blood pressure (HSBP), a significant public health challenge, has not been systematically studied in the elderly population in the context of global aging. Understanding the temporal trends of the disease burden associated with HSBP in the elderly population is essential to control and mitigate the harm caused by HSBP.

METHODS AND RESULTS

We used the estimated data derived from the Global Burden of Disease Study to analyse the disease burden of HSBP among the elderly population by region, sex, and temporal changes from 1990 to 2019. We found that the number of deaths due to HSBP increased to 7.86 (95% UI: 6.89-8.82) million, with an increase of 54.1%, and the number of disability-adjusted life years (DALYs) increased to 146 (95% UI: 130-162) million, with an increase of 52.4%. Conversely, the death and DALY rates of HSBP decreased by -27.0 and -27.8%, respectively. At the national and regional levels, Australasia and other high socio-demographic index regions have made significant improvements in the burden of HSBP, while it remains high in other regions of the world. Additionally, the burden of HSBP in older men is greater than that in older women.

CONCLUSION

Our findings indicate that the current prevention and control of HSBP in older adults is poor, with the total burden increasing significantly. There is an urgent need to implement feasible measures to resist HSBP and lessen the disparity of the global HSBP burden for older adults.

Acute Citrulline Blunts Aortic Systolic Pressure during Exercise and Sympathoactivation in Hypertensive Postmenopausal Women

PURPOSE

Hypertensive postmenopausal women (PMW) have exaggerated exercise systolic blood pressure (SBP) due to impaired functional sympatholysis. l-Citrulline (CIT) supplementation attenuates aortic SBP responses to cold pressor test (CPT)-induced vasoconstriction in young men. We hypothesized that acute CIT ingestion would attenuate aortic SBP and leg hemodynamic responses during exercise and CPT (EX + CPT).

METHODS

Fifteen hypertensive PMW (61 ± 7 yr) were randomly assigned to consume either 6 g of CIT or placebo (PL) separated by a minimum 3-d washout phase. Brachial and aortic blood pressure, femoral artery blood flow (FBF), and vascular conductance (FVC) were measured at rest and during 5 min of unilateral plantarflexion exercise with a CPT applied during minutes 4 and 5.

RESULTS

No differences between conditions were found in FBF, FVC, and brachial and aortic blood pressure at rest and during exercise alone. Changes in brachial SBP (CIT vs PL, 29 ± 12 vs 40 ± 10 mm Hg) and mean arterial pressure (CIT vs PL, 21 ± 10 vs 33 ± 11 mm Hg), and aortic SBP (CIT vs PL, 27 ± 11 vs 38 ± 9 mm Hg) and mean arterial pressure (CIT vs PL, 23 ± 9 vs 33 ± 11 mm Hg) to EX + CPT were lower in the CIT versus PL condition (P < 0.05). FBF, FVC, and functional sympatholysis (%ΔFVC) were not significantly different between conditions.

CONCLUSIONS

Acute CIT ingestion attenuated aortic SBP response to exercise and cold-induced sympathetic activation that may prevent left ventricle overload in hypertensive PMW.

The effects of slow loaded breathing training on exercise blood pressure in isolated systolic hypertension

OBJECTIVES

Slow loaded breathing training has been shown to reduce resting blood pressure (BP) in isolated systolic hypertension (ISH), but it is not known whether this also reduces their exaggerated BP responses to exercise.

METHODS

The study was a randomized controlled trial with block allocation stratified by sex. Twenty ISH patients (68 ± 5 yrs, 11 males) were randomized with one group undertaking 8-weeks training with slow loaded breathing (SLB: 25% maximum inspiratory pressure, 6 breaths per minute, 60 breaths every day) or deep breathing control (CON), with 8 weeks follow-up. Outcome measures were home BP and heart rate (HR) with laboratory measures of BP and HR responses to static handgrip and dynamic arm cranking exercise. Data were compared with a two-week run-in baseline.

RESULTS

Home systolic BP fell by 22 mmHg (20-23; mean, 95% CI), diastolic BP by 9 mmHg (7-11), and HR by 12 bpm (9-15; all p < .001) as a result of SLB training. Systolic BP at the end of 2-min isometric handgrip was 189 ± 10 mmHg (mean, SD) before training and 157 ± 6 mmHg following SLB training. After 4-min arm exercise, systolic BP, measured at the ankle, was reduced from 243 ± 8 mmHg during the run-in period to 170 ± 15 mmHg after SLB training with no change for CON. The reduction in exercise BP, in both types of exercise, was partly due to a reduction in resting BP and to a smaller increase above resting. Systolic and pulse pressures remained below run-in values 8 weeks after the end of SLB training, and BP response to handgrip exercise remained below run-in values at 4 weeks after SLB training.

CONCLUSIONS

SLB not only reduces resting BP in ISH but also the responses to both static and dynamic exercise, potentially reducing the negative aspect of exercise for cardiovascular health.

The effect of slow-loaded breathing training on the blood pressure response to handgrip exercise in patients with isolated systolic hypertension

Isolated systolic hypertension (ISH) is the most common form of hypertension in older people. It is characterized by increased resting systolic blood pressure (sBP) and increased sBP in response to exercise. It has previously been shown that slow breathing training reduces resting sBP, and the objective of the present study was to determine whether it also reduced the blood pressure response to static handgrip exercise. ISH patients aged between 60 and 74 years were randomly divided into a control group (10 subjects, 4 of which were male) that breathed normally and a trained group (10 subjects, 4 of which were male) that trained daily for 8 weeks by slow breathing against an inspiratory resistance of 18 cmH₂O. Before and immediately after training, subjects underwent a 2-min handgrip test (30% max) followed by 2 min of post-exercise circulatory occlusion (PECO) to assess metaboreflex activity. Training reduced sBP by 10.6 mm Hg (95% confidence interval (CI), -16 to -5 mm Hg, P=0.004), but changes were not observed in the control group. The peak exercise sBP was reduced by 23 mm Hg (95% CI, -16 to -31 mm Hg, P<0.001), while the increase in the sBP above resting was reduced by 12.6 mm Hg (95% CI, -6.9 to -18.2 mm Hg, P=0.002). The sBP during PECO was reduced by 8.9 mm Hg (95% CI, -4 to -14 mm Hg, P=0.008), which is indicative of reduced metaboreflex activity; no such change was observed in the control group. The results demonstrate that conventional treatment of older patients with ISH may be improved in two ways by slow breathing training: resting sBP may be reduced by 10 mm Hg, more than can be achieved by conventional pharmacological therapies, while the response to static exercise may be reduced by approximately twice this value.

Influence of L-citrulline and watermelon supplementation on vascular function and exercise performance

PURPOSE OF REVIEW

L-Citrulline, either synthetic or in watermelon, may improve vascular function through increased L-arginine bioavailability and nitric oxide synthesis. This article analyses potential vascular benefits of L-citrulline and watermelon supplementation at rest and during exercise.

RECENT FINDINGS

There is clear evidence that acute L-citrulline ingestion increases plasma L-arginine, the substrate for endothelial nitric oxide synthesis. However, the subsequent acute improvement in nitric oxide production and mediated vasodilation is inconsistent, which likely explains the inability of acute L-citrulline or watermelon to improve exercise tolerance. Recent studies have shown that chronic L-citrulline supplementation increases nitric oxide synthesis, decreases blood pressure, and may increase peripheral blood flow. These changes are paralleled by improvements in skeletal muscle oxygenation and performance during endurance exercise. The antihypertensive effect of L-citrulline/watermelon supplementation is evident in adults with prehypertension or hypertension, but not in normotensives. However, L-citrulline supplementation may attenuate the blood pressure response to exercise in normotensive men.

SUMMARY

The beneficial vascular effects of L-citrulline/watermelon supplementation may stem from improvements in the L-arginine/nitric oxide pathway. Reductions in resting blood pressure with L-citrulline/watermelon supplementation may have major implications for individuals with prehypertension and hypertension. L-Citrulline supplementation, but not acute ingestion, have shown to improve exercise performance in young healthy adults.