Delayed Blood Pressure Recovery Research Articles

Delayed blood pressure recovery after exercise stress test is associated with autonomic dysfunction and pulse pressure in a middle-aged healthy group.

Delayed heart rate (HR) and blood pressure recovery after exercise test is known as the reliable indexes of autonomic dysfunction. Here we tried to evaluate the serial changes in various indicators during exercise test and correlations with recovery of HR and blood pressure in a normotensive healthy middle-aged group. A total of 122 patients without hypertension or diabetes was enrolled (mean age, 55.6 ± 11.0; male, 56.6%; mean blood pressure, 124.8 ± 16.6 / 81.5 ± 9.6 mmHg). Treadmill test was performed for evaluation of chest pain. Patients with coronary artery disease, positive treadmill test result, left ventricular dysfunction or renal failure were excluded. Heart rate recovery was calculated by subtracting the HR in the first or second minute of recovery period from the HR of peak exercise (HRR1 or HRR2). Systolic blood pressure in the 4th minute of recovery stage (SBPR4) was used to show delayed blood pressure recovery. Metabolic equivalents (METs) and HR in stage 2 to 4 were significantly correlated with both HRR1 and HRR2. Multiple regression analysis of HRR revealed significant correlation of METs and SBPR4. SBPR4 was significantly correlated with both HRR1 and HRR2 (HRR1, r = -0.376, p<0.001; HRR2, r = -0.244, p = 0.008) as well as SBP in the baseline to stage 3 and pulse pressure (r = 0.406, p<0.001). Delayed BP recovery after peak exercise test revealed significant association with autonomic dysfunction and increased pulse pressure in normotensive middle-aged healthy group. It can be a simple and useful marker of autonomic dysfunction and arterial stiffness.

207 What is the association between psychotropic medication use and orthostatic hypotension in community-dwelling older people: data from TILDA

Abstract Background Psychotropic medications increase the risk of falls among older people. The aim of this study is to examine the link between psychotropic medication use and Orthostatic Hypotension (OH), a frequent cause of falls in later life. Methods: Participants ≥65 years at TILDA Wave 1 had an active stand to assess orthostatic blood pressure. OH was defined as a blood pressure (BP) drop ≥20 mmHg systolic and/or ≥ 10 mm Hg diastolic beyond 30 seconds post-standing. Medication lists were examined for the following anatomic therapeutic chemical classification codes: N06A (Antidepressants); N05BA, N05CD, N03AE (Benzodiazepines); ‘N05CF (‘Z’ Drugs); N05A (Antipsychotics) and medications with ‘definite’ anticholinergic effects on the Anticholinergic Cognitive Burden Scale. Logistic regression models, reporting odds ratios (OR), assessed the association between psychotropic medication use and OH. Analyses were adjusted for age, sex, educational attainment, alcohol excess, depression, cognitive impairment, chronic disease burden, heart disease and sleep quality. Results Of the 1,875 participants (mean age 71 years, 52% female), 12% were prescribed ≥1 psychotropic medication (234/1,875), while 4% (78/1,875) were prescribed ≥2. Psychotropic medication use was associated with a larger drop in systolic BP at 30 seconds (7.81 (95% CI 5.61–10.02) vs 3.46 (95% CI 2.61–4.32) mm Hg; p &amp;lt; 0.001) and 60 seconds (4.02 (95% CI 1.82–6.21) vs 1.28 (0.44–2.13); p = 0.025) post standing. In fully adjusted models, psychotropic medication use was associated with a higher likelihood of OH (OR 1.50 (95% CI 1.10–2.08; p = 0 0.013), with a stronger association noted for those taking ≥2 psychotropics (OR 2.19 (95% CI 1.34–3.57); p = 0.002). Conclusion Psychotropic medication use is independently associated with delayed BP recovery after standing. Older people prescribed psychotropics have a 50% higher likelihood Of OH related to their use, highlighting the importance of reviewing these medications as part of a comprehensive geriatric assessment, particularly in older people with falls.

PS-BPP02-1: EFFECTS OF INCREASED ARTERIAL STIFFNESS ON HEMODYNAMIC RESPONSE DURING AND AFTER SUBMAXIMAL STEP EXERCISE TEST IN MIDDLE-AGED NORMOTENSIVE INDIVIDUALS

Objective: This study was designed to examine the effects of increased arterial stiffness on hemodynamic response during and after simple step exercise test in middle-aged normotensive individuals. Design and method: The study participants consisted of 819 untreated normotensive individuals (aged 54.8 years; 39.6% men) without a history of cardiovascular disease, stroke, and renal disease. The participants underwent a submaximal step exercise test (25 steps/min for 2 min). Brachial arterial blood pressure (BP) and pulse rate were measured at 1-min interval before, during, and after the step exercise test. During the end of exercise (exercise SBP) and 2 min after exercise (recovery SBP) were evaluated. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness using an oscillometric device. Results: The mean values of resting SBP, exercise SBP, and recovery SBP were 121 ± 12 mmHg, 153 ± 17 mmHg, and 130 ± 14 mmHg, respectively. The individuals with increased baPWV (&gt; = 1400 cm/s, n = 305) showed significantly higher exercise SBP and recovery SBP than those with normal baPWV (Exercise, 162 ± 16 mmHg vs. 148 ± 16 mmHg, P &lt; 0.001; Recovery, 138 ± 13 mmHg vs. 125 ± 13 mmHg, P &lt; 0.001). The odds ratios for an exaggerated exercise SBP (&gt; = 180 mmHg) and delayed recovery SBP (&gt; = 150 mmHg) in individuals with increased baPWV were 2.7 (95%CI, 1.8–4.9; P = 0.001) and 3.3 (95%CI, 1.8–6.2; P &lt; 0.001) after adjusting for age, gender, body mass index, and resting SBP. When participants were divided according to a combination of exercise SBP and recovery SBP, the baPWV of the subgroup with exaggerated exercise SBP and delayed SBP recovery was higher than that of those with only exaggerated exercise SBP and delayed SBP recovery (Both, 1585 ± 301 cm/s; Exercise, 1505 ± 232 cm/s; Recovery, 1475 ± 160 cm/s). Conclusion: Exaggerated BP increase and delayed BP recovery during submaximal step exercise test are associated with increased arterial stiffness in normotensive individuals. Subclinical vascular impairment may influence vascular reactivity to a greater degree than basal tone and could be identified by an abnormal BP response to exercise even before clinical manifestation of hypertension.

Diagnosis of orthostatic hypotension in older people

Orthostatic hypotension (OH) can be classified to classic OH, delayed OH, initial OH, and delayed blood pressure recovery. It causes various symptoms such as lightheadedness, dizziness, visual blurring, and fall. Furthermore, the importance of OH is emphasized because it increases morbidity and mortality, especially in the elderly. Because neurogenic and non-neurologic components cause OH, an appropriate diagnosis is required to differentiate it.

138 DELAYED BLOOD PRESSURE RECOVERY AFTER STANDING INDEPENDENTLY PREDICTS FRACTURE IN COMMUNITY-DWELLING OLDER PEOPLE

Abstract Background Orthostatic hypotension, characterized by delayed blood pressure recovery (DBPR) after standing, is a risk factor for falls but the longitudinal relationship with fracture is not yet known. The aim of this study was to examine the prospective risk of fracture associated with DBPR. Methods This study, embedded within the Irish Longitudinal Study on Ageing (TILDA), examined prospective risk of fracture (hip, wrist or vertebral) associated with DBPR at 8-year follow-up in a population-representative sample of more than 3,000 (54% female) community-dwelling older people. Orthostatic blood pressure (BP) was measured using a finometer during active stand at TILDA Wave 1. DBPR was defined as systolic BP ≤ 20 mmHg lower and/or diastolic BP ≤ 10 mmHg from baseline value at 30, 60 and 90 seconds after standing. Participants with a fracture reported at any of Waves 2–5 were defined as having ‘Incident Fracture’. Logistic regression models were used to estimate odds ratios (ORs) for the association between DBPR and incident fracture. Results Seven percent (212/3117) of participants sustained a fracture during follow-up. DBPR at 30 seconds was a significant predictor of any fracture [OR 1.80, 95% confidence interval (CI) 1.28–2.53] and hip fracture (OR 4.44, 95% CI 2.03–9.71) in fully adjusted models. DBPR at 30 seconds did not predict wrist or vertebral fracture. DBPR at 60 seconds also predicted any fracture (OR 1.74, 95% CI 1.19–2.54) and hip fracture (OR 4.66, 95% CI 2.12–10.26) whereas DBPR at 90 seconds predicted any (OR 1.99, 95% CI 1.38–2.87), wrist (OR 1.87, 95% CI 1.19–2.95), and hip fracture (OR 3.39, 95% CI 1.45–7.93) in fully adjusted models. Conclusion Delayed BP recovery independently predicts fracture in community-dwelling older people, is potentially modifiable, and can be measured in an ambulatory setting. Given the morbidity and mortality associated with fractures, identification of such risk factors is crucial in order to inform preventative strategies.

Delayed Blood Pressure Recovery After Standing Independently Predicts Fracture in Community-Dwelling Older People

ObjectivesOrthostatic hypotension, characterized by delayed blood pressure (BP) recovery after standing, is a risk factor for falls but the longitudinal relationship with fracture is not yet known. The aim of this study was to examine the prospective risk of fracture associated with delayed BP recovery. DesignLongitudinal study with 8-year follow-up. Setting and ParticipantsMore than 3000 (54% female) community-dwelling people aged ≥50 years from a large longitudinal study on ageing. MethodsOrthostatic BP was measured using a finometer when standing from lying. Delayed BP recovery was defined as systolic BP ≥20 mm Hg lower and/or diastolic BP ≥10 mm Hg from the baseline value at 30, 60, and 90 seconds after standing. Participants with a fracture reported at any of waves 2 to 5 were defined as having incident fracture. Logistic regression models were used to estimate odds ratios (ORs) for the association between delayed BP recovery and incident fracture. ResultsSeven percent (212/3117) of participants sustained a fracture during follow-up. Delayed BP recovery at 30 seconds was a significant predictor of any fracture [OR 1.80, 95% confidence interval (CI) 1.28-2.53] and hip fracture (OR 4.44, 95% CI 2.03-9.71) in fully adjusted models. Delayed BP recovery at 30 seconds did not predict wrist or vertebral fracture. Delayed BP recovery at 60 seconds also predicted any fracture (OR 1.74, 95% CI 1.19-2.54) and hip fracture (OR 4.66, 95% CI 2.12-10.26) whereas delayed BP recovery at 90 seconds predicted any (OR 1.99, 95% CI 1.38-2.87), wrist (OR 1.87, 95% CI 1.19-2.95), and hip fracture (OR 3.39, 95% CI 1.45-7.93) in fully adjusted models. Conclusionand Implications: Delayed BP recovery independently predicts fracture in community-dwelling older people, is potentially modifiable, and can be measured in an ambulatory setting. Because of the morbidity and mortality associated with fractures, identification of such risk factors is crucial in order to inform preventative strategies.

Exercise-related blood pressure response is related to autonomic modulation in young adults: A new extension study.

BACKGROUND: The delayed blood pressure recovery (BPR) at post-exercise has been in association with a major risk of cardiovascular disease and death.OBJECTIVE: The study focused on evaluating the systolic and diastolic blood pressure recovery (SBPR, DBPR) and the autonomic modulation following treadmill exercise in healthy young adults. Although considerable literature had been published about BPR and HRV, the association between BPR and ultra-short-term HRV has not yet been completely described.METHODS: Fifteen subjects performed exercise with three different intensities on a treadmill, the speed was 6 km/h, 9 km/h, 12 km/h, respectively. SBP and DBP was measured per 30 s in each trial. The synchronous 5-min electrocardiogram (ECG) signals were recorded and HRV parameters including SDNN, RMSSD, SDNN/RMSSD, SD1, SD2 and SD1/SD2 were calculated every 30 s periods in 5 min ECG signals to match the corresponding BPR.RESULTS: The intraclass correlation coefficient (ICC) values and the Bland-Altman plots indicated good consistency and repeatability between HRV and HRV at three post-exercise trials, with most ICC values 0.75. Besides, SBPR and DBPR generally decreased and returned to the Rest level in 5 mins. The Spearman correlation coefficients showed strong relationships between BPR and HRV sympathetic-vagal balance parameters, i.e., ratio SDNN/RMSSD and ratio SD1/SD2.CONCLUSIONS: These observations represented a new insight into the cardiovascular regulation at post-exercise, which could contribute to physical exercise areas in the future.

α-Adrenergic receptor blockade attenuates pressor response during mental stress in young black adults.

Black individuals exhibit increased blood pressure (BP) responses to sympathetic stimulation that are associated with an increased risk of hypertension (HTN). We tested the hypothesis that α1‐adrenergic blockade inhibits the increased BP response during and after 45‐min stress in young normotensive Black adults, which may be mediated, in part, by dampened vasoconstriction and decreased renal sodium retention. Utilizing a double‐masked randomized, crossover study design, 51 normotensive Black adults (31 ± 8 yr) were treated with either a placebo or 1 mg/day of prazosin for 1 week. On the final day of each treatment, hemodynamic measures and urinary sodium excretion (UNaV) were collected before (Rest), during (Stress) and after (Recovery) 45 min of mental stress induced via a competitive video game task. During the Stress period, diastolic BP and total peripheral resistance (TPR) were significantly lower with prazosin compared to placebo (p < .05 for both). Similarly, we observed lower systolic BP, diastolic BP, and TPR during the Recovery period with prazosin versus placebo (p < .05 for both). There was no effect of prazosin on stress‐associated UNaV. The change in systolic BP from Rest to Recovery was positively associated with the change in TPR with both treatments (p < .05 for both). In summary, prazosin treatment dampened BP reactivity to 45‐min mental stress and lowered post‐stress BP over the recovery period, which was linked to reduce TPR in young normotensive Black adults. These results suggest that α1‐adrenergic receptor activity may contribute to BP responses and delayed BP recovery to prolonged mental stress through increased vasoconstriction in Black adults.

Hemodynamic Mechanisms Underlying Initial Orthostatic Hypotension, Delayed Recovery and Orthostatic Hypotension

ObjectivesContinuous noninvasive blood pressure (BP) measurement enables us to observe rapid changes in BP and to study underlying hemodynamic mechanisms. This study aimed to gain insight into the pathophysiological mechanisms underlying short-term orthostatic BP recovery patterns in a real-world clinical setting with (pre)syncope patients. Setting and ParticipantsIn a prospective cohort study, the active lying-to-standing test was performed in suspected (pre)syncope patients in the emergency department with continuous noninvasive finger arterial BP measurement. MeasuresChanges in systolic BP, cardiac output (CO), and systemic vascular resistance (SVR) were studied in normal BP recovery, initial orthostatic hypotension, delayed BP recovery, and sustained orthostatic hypotension. ResultsIn normal recovery (n = 47), ΔBP at nadir was −24 (23) mmHg, with a CO change of +10 (21%) and SVR of −23 (21%). In initial orthostatic hypotension (n = 7) ΔBP at nadir was −49 (17) mmHg and CO and SVR change was −5 (46%) and −29 (58%), respectively. Delayed recovery (n = 12) differed significantly from normal recovery 30 seconds after standing, with a ΔBP of −32 (19) vs 1 (16) mmHg, respectively. Delayed recovery was associated with a significant difference in SVR changes compared to normal recovery, −17 (26%) vs +4 (20%), respectively. There was no difference in CO changes. In sustained orthostatic hypotension (n = 16), ΔBP at 180 seconds after standing was −39 (21) mmHg, with changes in CO of −16 (31%) and SVR of −9 (20%). Conclusions/ImplicationsHemodynamic patterns following active standing are heterogeneous and differ across orthostatic BP recovery patterns, suggesting that volume status, medication use, and autonomic dysfunction should all be taken into account when evaluating these patients. Moreover, results suggest that a delayed BP recovery is associated with an impaired increase in SVR in a significant proportion of individuals, implying that physicians treating older adults with hypertension should consider the possible negative effect of intensive hypertension treatment on initial orthostatic blood pressure control.

Relations entre gain baroréflexe et autres marqueurs de risque chez le patient diabétique de type 2

Aim of the studyThe present work is studying the relationships between baroreflex gain (BRG), pulse pressure (PP) and estimated glomerular filtration rate (eGFR) in type 2 diabetic (T2D) patients. Patients and methodsA continuous non-invasive monitoring (Finapres®) of blood pressure (BP) and heart rate (HR) during a standardized postural manoeuvre (squatting test) was performed in 64 T2D patients allowing the calculation of BRG during the squatting to standing transition and the increase in PP during the standing to squatting transition. eGFR was calculated using the MDRD formula and glycated haemoglobin (HbA1c) was measured at baseline and after a follow-up of 12±5 years. ResultsWhen compared to patients with a high BRG (n=30), patients with a low BRG (n=34) were slightly older, but had a similar sex ratio and comparable duration of diabetes, HbA1c level and BP values. They had a higher baseline HR, a greater elevation of PP during squatting and a more pronounced BP fall when standing up, with delayed BP recovery and a less marked tachycardia. While eGFR was significantly lower at baseline in patients with low BRG, the subsequent reduction in eGFR during the 12 years of follow-up was comparable between the two groups. ConclusionA low BRG, a marker of cardiac autonomic neuropathy, is associated with a higher PP in squatting position, a marker of arterial fitness, and a reduction in eGFR (nephropathy), but does not predict the subsequent deterioration of renal function.

Visceral fat enhances blood pressure reactivity to physical but not mental challenges in male adolescents.

Excess visceral fat is a major risk factor for hypertension. Enhanced blood pressure (BP) reactivity and delayed BP recovery from physical and mental challenges predict future hypertension. Determine whether visceral fat is associated with higher BP reactivity and delayed BP recovery from physical and mental challenges during adolescence. In a community-based sample of 283 male and 308 female adolescents, we measured visceral fat with magnetic resonance imaging, total body fat with bioimpedance, and beat-by-beat BP with a Finometer at rest and during physical (10-min standing) and mental (2-min math stress) challenges. Males vs. females showed greater BP reactivity and no differences in BP recovery from either type of challenges. Visceral fat was positively associated with BP reactivity to standing up only and in males only (+8.4 ± 3.6 mmHg per 1 log cm(3) of visceral fat, P = 0.008), and this association was independent of total body fat. No association was seen between visceral fat and BP recovery from either type of challenge in either sex. All these associations were independent of age, puberty stage, height and initial BP. Adolescent males vs. females demonstrate greater BP reactivity but similar BP recovery from physical and mental challenges. Excess visceral fat enhances BP reactivity to physical but not mental challenges in males only.

The Effect of Exercise and Distraction on Blood Pressure Recovery Following an Anger-Provoking Stressor in Normotensive Young Adults

Ruminating about a prior anger provoking event is found to elevate blood pressure (BP) and delay BP recovery. Delayed BP recovery may be associated with increased risk of hypertension. Interventions that improve BP recovery may be beneficial for cardiovascular health. The purposes of this study were to evaluate the influence of rumination and anger on BP reactivity and recovery, to compare the effect of an exercise intervention or distraction intervention on BP recovery and to explore if exercise improved BP recovery by distracting participants from stressor-related rumination and anger. Healthy, normotensive participants (n = 79, mean age 22.2 ± 4.0 years) underwent an anger-recall interview stressor task, 3 min of exercise (walking), distraction (reading) or no-intervention (quiet sitting) and a 15 min recovery period. State anger reactivity was associated with Δ diastolic (D) BP reactivity and approached significance with Δ systolic (S) BP reactivity. Trait rumination was associated with greater SBP during recovery. Δ SBP recovery did not differ between the exercise, distraction and no-intervention groups. Although there were no differences in Δ DBP recovery between the exercise and no-intervention groups, distraction improved Δ DBP recovery compared to the exercise intervention but not the no-intervention. The proportion of anger-related thoughts (state rumination) in the exercise group did not differ from the distraction or no-intervention groups. However, a smaller proportion of participants in the distraction intervention reported an anger-related thought during recovery compared to the no-intervention group with 76% of their thoughts relating to the provided distraction. Overall, post-stressor exercise was not found to improve BP recovery while reading was effective at distracting individuals from angry thoughts (state rumination) but had no effect on BP compared to no-intervention.

Delayed Blood Pressure Recovery Ratio and Its Relation to Endothelial Function and Left Ventricular Diastolic Function in Prediabetics

Endothelial function plays a key role in determining the clinical manifestations of established atherosclerotic lesions and has shown to be associated with suppressed sympathetic tone. Abnormal heart rate recovery (HRR) and systolic blood pressure (SBP) response during recovery has been found to have diagnostic role for detecting cardiovascular risk. To investigate whether with abnormal HRR and delayed SBP recovery ratio after exercise could predict endothelial dysfunction in prediabetic subjects. Ninety-two prediabetic patients underwent brachial artery flow-mediated dilatation (FMD) test and a maximal exercise stress test. Seventy-eight healthy subjects served as a control group. HRR at 1 minute (HRR1 ) and SBP recovery ratio (SBPRR3 ) was defined as the SBP at minute 3 of recovery divided by SBP at peak exercise. Left ventricular diastolic function was assessed utilizing both conventional and tissue Doppler echocardiography. Flow-mediated dilatation was significantly decreased in prediabetics versus controls (P < 0.0001). Isovolumetric relaxation time and E/E' were significantly increased in prediabetics (P < 0.01 and <0.001). Delayed SBPRR3 was significantly correlated with impaired endothelial function and (E/E') in prediabetics (r = 0.62, P < 0.001 and r = 0.56, P < 0.001, respectively). Stepwise linear regression analysis revealed that HRR1 and SBPRR3 were significant predictors of endothelial dysfunction (r = 0.61, r(2) = 0.37, P < 0.01 and r = 0.51; r(2) = 27; P < 0.0001). Abnormal HRR1 and delayed SBP response detected during recovery imply a significant correlation with impaired endothelial function and diastolic dysfunction in prediabetics.

Childhood Poverty and Blood Pressure Reactivity to and Recovery From an Acute Stressor in Late Adolescence

Childhood deprivation is inimical to health throughout the life course. Early experiences of stress could play a role in health inequalities. An important aspect of childhood poverty that has not received much attention is cardiovascular reactivity to and recovery from acute stressors.Piecewise, multilevel growth curve regression was used to examine blood pressure reactivity to and recovery from a mental arithmetic task among late adolescents (mean [standard deviation] = 17.3 [1.0] years, n = 185) as a function of early childhood poverty (9 years). We also tested whether exposure to family conflict at age 13 years mediated expected linkages between childhood poverty and adolescent blood pressure reactivity and recovery to an acute stressor.Blood pressure reactivity was unaffected by household income during childhood, but late adolescents with lower household income during childhood showed slower systolic (b = -0.29, p = .004) and diastolic (b = -0.19, p = .002) recovery. These results include age and sex as statistical covariates. The significant poverty impact on systolic but not on diastolic blood pressure recovery was mediated by exposure to family conflict (95% confidence interval = - 0.1400 to - 0.0012).We show that late adolescents who grew up in poverty have delayed blood pressure recovery from an acute stressor. Furthermore, childhood exposure to family conflict, a well-documented component of early childhood deprivation, accounted for some of the adverse effects of childhood poverty on stressor recovery among these adolescents. We discuss the importance of considering physiological stress accompanying early experiences of deprivation in thinking about health inequalities.

Delayed blood pressure recovery ratio might indicate increased arterial stiffness in hypertensive patients with reduced aerobic exercise capacity

Background: Cardiopulmonary fitness is associated with reduced cardiovascular risk. Abnormal systolic blood pressure (SBP) response during recovery has been found to have diagnostic role for detecting cardiovascular risk. Aim of the study was to determine whether increased arterial stiffness associates with reduced aerobic exercise capacity after maximal cardiopulmonary exercise test (CPET) in a cohort of recently diagnosed hypertensive patients with a delayed decline in SBP during recovery. Methods: Eighty-four hypertensive patients with recently diagnosed I–II essential hypertension and under treatment with RAAS antagonists ± HCTZ, underwent pulse wave velocity (PWV) estimation and a maximal CPET. Fifty-four healthy normotensive subjects served as a control group. Blood pressure recovery ratio (BPRR) was defined as the SBP after 3 min recovery divided by SBP at peak exercise. Results: PWV was significantly increased in hypertensives vs normotensives (p < 0.001). A non-independent, reverse association between PWV and VO2PEAK was revealed in hypertensives with delayed BPRR (r = − 0.49, p < 0.05). Age and sex independently predicted VO2PEAK in hypertensives with delayed BPRR. Conclusions: Delayed blood pressure response detected during recovery in treated hypertensives implies a reverse relationship between any given impaired aerobic exercise capacity and expected persistent peripheral vascular resistance during exercise.

The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension

Delayed blood pressure (BP) and heart rate (HR) decline at recovery post-exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non-CAD patients (374 normotensive) were followed for new-onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow-up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New-onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28-2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08-2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03-4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14-4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components.

Haemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes

Cardiovascular autonomic neuropathy (CAN) and pulsatile stress are considered to be independent cardiovascular risk factors. This study compared haemodynamic changes during an active orthostatic test in adult patients with type 1 diabetes (T1DM), using low versus high RR E/I ratios as a marker of CAN. A total of 20 T1DM patients with low RR E/I ratios were compared with 20 T1DM patients with normal RR E/I ratios, matched for gender (1/1 ratio), age (mean: 46 years) and diabetes duration (22-26 years); 40 matched healthy subjects served as controls. All subjects were evaluated by continuous monitoring of arterial blood pressure (Finapres(®)) and heart rate using a standardized posture test (1-min standing, 1-min squatting, 1-min standing), thus allowing calculation of baroreflex gain. Compared with controls, T1DM patients showed lower RR E/I ratios, reduced baroreflex gains, higher pulsatile stress (pulse pressure×heart rate), greater squatting-induced pulse pressure rises, orthostatic hypotension and reduced reflex tachycardia. Compared with T1DM patients with preserved RR E/I ratios, T1DM patients with low RR E/I ratios showed reduced post-standing reflex tachycardia and baroreflex gain, and delayed blood pressure recovery, but no markers of increased pulsatile stress. Interestingly, decreased baroreflex gain was significantly associated with both pulsatile stress and microalbuminuria. The use of RR E/I ratios to separate T1DM patients allows the detection of other CAN markers during an orthostatic posture test, but with no significant differences in pulsatile stress or microalbuminuria. In this context, squatting-derived baroreflex gain appears to be more informative.

Orthostatic Hypotension and Cardiovascular Risk

Orthostatic hypotension (OH) results from a failure of neural and circulatory mechanisms to compensate for the reduction in venous return that normally occurs on assuming the upright posture. OH is defined as a fall in systolic blood pressure of ≥20 mm Hg or diastolic blood pressure of ≥10 mm Hg measured within 3 minutes of standing.1 OH can result from side effects of medications, intravascular volume loss, systemic diseases that involve autonomic nerves (eg, diabetes mellitus or amyloidosis), and, in rare cases, it can be the initial sign of a primary autonomic failure syndrome (multiple system atrophy, pure autonomic failure, and Parkinson’s disease). Severe OH can be a dramatic medical condition, with affected patients unable to stand but for few seconds before disabling symptoms of cerebral hypoperfusion and syncope ensue. Asymptomatic OH is a far more common condition, but one that is often unrecognized. It is a frequent finding in the elderly, with prevalence reported between 6% and 35% or more, depending on the age group and associated comorbidities.2,3 During the past 2 decades, evidence from cross-sectional and longitudinal epidemiological studies has identified OH as an independent risk factor for cardiovascular morbidity and all-cause mortality.4 In prospective studies, the presence of OH at baseline increased the risk of subsequent adverse outcomes, including stroke,5 coronary heart disease,6 and all-cause mortality.2,4,7,8 In this …

Delayed blood pressure recovery after head‐up tilting during sleep in preterm infants

Dramatic changes in cardiovascular control occur in sleep during infancy, when sleep time is at a lifetime maximum. In infants born preterm there are significant cardiovascular complications later in life, and also an increased risk for sudden infant death syndrome (SIDS), possibly a result of inadequate compensation to a cardiorespiratory challenge in sleep. We aimed to examine the consequences of preterm birth on heart rate (HR) and blood pressure (BP) responses to head-up tilting (HUT) during sleep in infants. Preterm (n = 25) and term (n = 20) infants were studied using daytime polysomnography at 2-4 weeks', 2-3 months' and 5-6 months' term-corrected age (CA). BP was recorded using a photoplethysmographic cuff (Finometer); 15 degrees HUTs were performed during both quiet and active sleep. Preterm infants responded to HUT with increased HR and BP, followed by a bradycardia and a subsequent return of HR and BP to baseline. Overall, HUT responses were similar between term and preterm infants at matched ages. Notably, however, return of BP to baseline was considerably delayed in preterm infants ( approximately 37 beats post-tilt) compared with term infants ( approximately 23 beats post-tilt) at both 2-4 weeks' and 2-3 months' CA (P < 0.05). Our study has demonstrated that preterm infants respond to a BP perturbation with changes in HR that match those of term infants. However, delayed recovery of BP during sleep in the preterm infant may be indicative of underlying deficits or immaturity in vascular function or control, which may contribute to their vulnerability to SIDS and cardiovascular complications later in life.

Low vagal tone is associated with impaired post stress recovery of cardiovascular, endocrine, and immune markers

Reduced heart rate variability (HRV) and delayed blood pressure recovery are associated with increased cardiovascular risk. Besides this evident link, the vagus is thought to play an inhibitory role in the regulation of other allostatic systems, including inflammation and the hypothalamic-pituitary-adrenal (HPA) axis. However, human evidence is scarce. To further explore these associations and with special regard to the postulated mediating role of the vagus, we hypothesised that subjects with low vagal tone as indexed by reduced resting HRV would show impaired post-stress recovery of cardiovascular, endocrine and immune system markers involved in cardiovascular pathology. 44 healthy men underwent a standardised mental stress test. Besides continuous measurement of systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and HRV serum cortisol, tumour necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) were measured before, after, 20, and 60 min after stress. Low versus high HRV groups was defined by median split on resting HRV (RMSSD). The task elicited significant time effects for SBP, DBP, HR, HRV, cortisol, and TNF-alpha. Subjects with low baseline HRV showed almost no modulation of HRV coupled with overall reduced HRV levels, and impaired recovery of DBP, cortisol, and TNF-alpha. Confirming our hypothesis, low vagal tone was associated with impaired recovery of cardiovascular, endocrine, and immune markers in healthy males. The data support an inhibitory role of the vagus in the regulation of allostatic systems as described in the neurovisceral integration model. We posit reduced resting HRV as a risk marker for future cardiovascular and other stress-related disease.