Diastolic Blood Pressure Recovery Research Articles

Physiological correlates of cognitive functioning in an elderly population

Cognitive decline in old age is not universal or inevitable. Associations have been observed with neuroendocrine function, but the relevance of other physiological processes is unclear. We predicted that impairment of memory in an ageing population would be related to the dysregulation of neuroendocrine and cardiovascular responses. One hundred and thirty-nine participants (65-80 years) were recruited from general practice in London. Two standardised verbal paired-associates recall tasks were administered in order to determine declarative memory performance, and a fluid intelligence task (matrix reasoning) was also performed. Salivary cortisol samples were collected every 10 min, while blood pressure and heart rate were measured before, during and after each task. Illness history and medication use were obtained from medical records. Multiple linear regression analysis, adjusted for age, gender, education, chronic illness, and medication use, revealed that cortisol responses were inversely related to memory performance. Additionally, superior memory was associated with more effective post-task recovery of heart rate (in both men and women) and diastolic blood pressure recovery in men. Cardiovascular recovery effects were independent of covariates, and of levels of heart rate and blood pressure measured during tasks themselves. These associations were also independent of subjective ratings of stress and perceived performance. Neither neuroendocrine nor cardiovascular responses were related to performance of the reasoning task. We conclude that memory in the elderly is associated both with hypothalamic-pituitary-adrenocortical function and cardiovascular regulation. Disturbances of neuroendocrine and hemodynamic function may be related to greater vulnerability to cognitive decline.

Impaired cardiovascular recovery following stress predicts 3-year increases in blood pressure

To assess whether variation in the rate of cardiovascular recovery following exposure to acute psychological stress predicts changes in blood pressure longitudinally, independently of blood pressure at baseline and other covariates. A 3-year longitudinal study. A total of 209 men and women aged 45-59 years at baseline, with no history of cardiovascular disease including hypertension. Measurement of blood pressure, heart rate, heart rate variability, cardiac index and total peripheral resistance at rest, during two moderately stressful behavioural tasks and up to 45 min post-stress. Stress reactivity was defined as the difference in values between tasks and baseline, and post-stress recovery as the difference between recovery levels and baseline. Resting blood pressure measured at baseline and 3 years later. Seven individuals had been prescribed hypertensive medication on follow-up. Increases in systolic blood pressure (SBP) were predicted by impaired post-stress recovery of SBP (P < 0.001), diastolic blood pressure (DBP) (P < 0.001) and total peripheral resistance (P = 0.003), independently of baseline blood pressure, age, gender, socio-economic status, hypertensive medication, body mass and smoking. The adjusted odds of an increase in SBP > or = 5 mmHg were 3.50 [95% confidence interval (CI) 1.19 to 10.8] for individuals with poor compared with effective post-stress recovery of SBP. Three-year increases in diastolic pressure were predicted by impaired recovery of SBP (P < 0.001) and DBP (P = 0.009) pressure and by heart rate variability during tasks (P = 0.002), independently of covariates. Impaired post-stress recovery and less consistently heightened acute stress reactivity may index disturbances in the regulation of cardiovascular stress responses that contribute to longitudinal changes in blood pressure in middle-aged men and women.

Alexithymia predicts attenuated autonomic reactivity, but prolonged recovery to anger recall in young women

Alexithymia has been prospectively associated with all-cause mortality and with cardiovascular morbidity. Here, stress-induced autonomic reactivity and recovery were examined as potential pathways linking alexithymia to cardiovascular disease. The relation of alexithymia to blood pressure, heart rate, and other cardiovascular parameters derived from impedance cardiography ( N=80) and heart rate variability ( N=40) was evaluated during rest, an anger recall task and recovery in women (ages 18–30). During anger recall, alexithymia was associated with significantly attenuated heart rate and stroke index reactivity, greater low frequency power, and with marginally dampened blood pressure and high frequency power reactivity. Overall, this response pattern suggests blunted sympathetic activation and diminished vagal withdrawal. Alexithymia was also related to slower diastolic blood pressure and quicker preejection period recovery implying abbreviated sympathetic arousal and possibly greater vagal modulation. These results impart some evidence for the hypoarousal model of alexithymia during reactivity, but the hyperarousal model during recovery. Autonomic dysregulation during and following acute emotional stress is suggested as a possible physiological pathway connecting alexithymia to cardiovascular disease.

Cardiovascular haemodynamic response to repeated mental stress in normotensive subjects at genetic risk of hypertension: evidence of enhanced reactivity, blunted adaptation, and delayed recovery.

To identify unique cardiovascular responses to stressors in a population at genetic risk of hypertension, we studied haemodynamic responses in initial reactivity to, subsequent adaptation to, and final recovery from repeated active mental stress in young, normotensive individuals stratified by hypertension parental history (PH). Two groups (n=21/group) of normotensive white males underwent stress testing. One group (N+PH) had a hypertensive parent, while the other group (N-PH) did not. Cardiovascular response was measured before, during, and after repeated serial-subtraction math. Initial reactivity was measured as the difference between baseline and initial stress response, subsequent adaptation as the difference in response to repeated trials, and final recovery was assessed by the difference between baseline and postbaseline levels. The influence of PH on reactivity, adaptation, and recovery was assessed by repeated measures ANOVA for stroke volume, cardiac output, pre-ejection period, total peripheral resistance, mean successive heartbeat time difference, blood pressure, and heart rate. Multivariate analysis of variance (MANOVA) determined the effect of PH on overall reactivity, adaptation, and recovery. As compared to the N-PH group, initial reactivity was higher in the N+PH group for cardiac index (P<0.05) and pre-ejection period (P<0.05). Subsequent adaptation in the N+PH group was significantly slower for pre-ejection period (P=0.03). Finally, the N+PH group showed delayed recovery in heart rate (P=0.03), diastolic blood pressure (P<0.05), and pre-ejection period (P=0.007). In conclusion, the heightened reactivity, lack of adaptation, and delayed recovery occur in the sympathetic system of normotensive subjects at genetic risk of hypertension, specifically in beta-adrenergic responses (pre-ejection period). The parasympathetic response (mean successive heartbeat time difference) was not different. Increased cardiac output reactivity in the N+PH group (P<0.05) thus precedes any difference in blood pressure reactivity (P<0.99). Delayed recovery of diastolic blood pressure is also found in the N+PH group (P<0.05), which suggests lower baroreceptor sensitivity. Since delayed recovery in heart rate (P=0.03), and diastolic blood pressure (P<0.05) occur in N+PH subjects even before the corresponding changes in reactivity (P>0.10) or adaptation (P>0.07) are seen, these recovery impairments may be among the earliest precursors to the development of essential hypertension in this population. Finally, PH group haemodynamic differences suggest that these traits (reactivity, adaptation, and recovery) may constitute early 'intermediate' phenotypes in the pathogenesis of hypertension.

Social Interactions and Cardiovascular Reactivity during Problem Disclosure among Friends

The authors examined the relations of social interactions with cardiovascular response in the context of two friends disclosing a problem. They also examined the relations of the sex composition of the dyad and partner gender-related traits (communion/agency) with social interactions. Same-sex and opposite-sex dyads (N = 79) came to the lab. One friend disclosed a real-life problem while the partner provided support; cardiovascular response was monitored. Women provided more emotional support than men, and this sex difference was due to women's higher levels of communion. Agency was linked with greater advice, whereas unmitigated communion was linked with greater negative interactions. Negative interactions predicted slower diastolic blood pressure (DBP) recovery, whereas advice predicted slower heart rate (HR) recovery. Sex composition of dyad moderated some of these effects.

Hostility and caffeine: cardiovascular effects during stress and recovery

Both hostility and caffeine are frequently cited as potential factors in coronary heart disease (CHD). The present study examined the independent and interactive effects of these important variables on cardiovascular functioning. The Cook–Medley Scale was used to select 24 high and 24 low hostile subjects, who received caffeine (400 mg) or a placebo (lactose) in a double-blind design. All completed mental arithmetic (MA) and anagram stress tasks during which they experienced periods of verbal harassment and non-harassment. Blood pressure and heart rate were recorded. The combination of high hostility and harassment increased diastolic blood pressure (DBP) and maintained elevated levels of mean arterial pressure (MAP) during task periods, while reducing DBP recovery during rest periods. Caffeine increased systolic blood pressure (SBP) and interacted with harassment to create an inverted-U effect, reducing blood pressure. Finally, hostility and caffeine interacted to maintain elevated levels of DBP during recovery periods. These results support the dual-interactional theory of personality and behavior, which suggests an interaction of genetic and environmental factors and of dispositional and situational factors.

Menstrual cycle, race and task effects on blood pressure recovery from acute stress

This study examined cardiovascular recovery from two standardized laboratory stressors in 68 healthy black and white normotensive women and men (mean age 33 years). Women were studied in a randomized order at the same time of day on two separate occasions, once during the follicular phase (days 7 to 10 following menses) and once during the luteal phase (days 7 to 10 following the leutenizing-hormone surge) of the menstrual cycle. Men were studied twice approximately 6 weeks apart. There were differential effects of the tasks on blood pressure recovery (change scores) with a mirror star task yielding poorer diastolic blood pressure recovery ( p=0.004) and an interpersonal speaking task yielding poorer systolic blood pressure recovery ( p=0.003). Across both tasks, blacks evidenced greater diastolic blood pressure recovery as compared to whites ( p=0.02). Black women showed greater diastolic blood pressure recovery in the luteal as compared to the follicular phase ( p=0.01), whereas white women evidenced no such change across the menstrual cycle. Correlation analysis across testing sessions generally revealed comparable temporal stability values for recovery as compared to reactivity measures. The findings support prior studies indicating racial differences in recovery from acute stress and extend these findings by suggesting that the menstrual cycle may differentially affect recovery in black versus white women.

Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study.

Although systolic blood pressure (SBP) response to exercise has been shown to predict subsequent hypertension in small samples of men, this association has not been studied in a large population-based sample of middle-aged men and women. The purpose of this study was to examine, in normotensive subjects, the relations of SBP and diastolic blood pressure (DBP) during the exercise and recovery periods of a graded treadmill test to the risk of developing new-onset hypertension. BP data from exercise testing in 1026 men and 1284 women (mean age, 42+/-10 years; range, 20 to 69 years) from the Framingham Offspring Study who were normotensive at baseline were related to the incidence of hypertension 8 years later. New-onset hypertension, defined as an SBP >/=140 mm Hg or DBP >/=90 mm Hg or the initiation of antihypertensive drug treatment, occurred in 228 men (22%) and 207 women (16%). Exaggerated SBP (Ex-SBP 2) and DBP (Ex-DBP 2) response and delayed recovery of SBP (R-SBP 3) and DBP (R-DBP 3) were defined as an age-adjusted BP greater than the 95th percentile during the second stage of exercise and third minute of recovery, respectively. After multivariable adjustment, Ex-DBP 2 was highly predictive of incident hypertension in both men (OR, 4.16; 95% CI, 2.15, 8.05) and women (OR, 2.17; CI, 1.19, 3.96). R-SBP 3 was predictive of hypertension in men in a multivariable model that included exercise duration and peak exercise BP (OR, 1.92; CI, 1.00, 3.69). Baseline resting SBP (chi2, 23.4 in men and 34.7 in women) and DBP (chi2, 11.3 in men and 13.1 in women) had stronger associations with new-onset hypertension than exercise DBP (chi2, 16.4 in men and 6.1 in women) and recovery SBP (chi2, 6.5 in men and 2.1 in women) responses. An exaggerated DBP response to exercise was predictive of risk for new-onset hypertension in normotensive men and women. An elevated recovery SBP was predictive of hypertension in men. These findings may reflect subtle pathophysiological features in the preclinical stage of hypertension.

414 Psychometric and neurophysiological approaches to latent hepatic encephalopathy in cirrhotics patients

Alexithymia has been prospectively associated with all-cause mortality and with cardiovascular morbidity. Here, stress-induced autonomic reactivity and recovery were examined as potential pathways linking alexithymia to cardiovascular disease. The relation of alexithymia to blood pressure, heart rate, and other cardiovascular parameters derived from impedance cardiography (N=80) and heart rate variability (N=40) was evaluated during rest, an anger recall task and recovery in women (ages 18–30). During anger recall, alexithymia was associated with significantly attenuated heart rate and stroke index reactivity, greater low frequency power, and with marginally dampened blood pressure and high frequency power reactivity. Overall, this response pattern suggests blunted sympathetic activation and diminished vagal withdrawal. Alexithymia was also related to slower diastolic blood pressure and quicker preejection period recovery implying abbreviated sympathetic arousal and possibly greater vagal modulation. These results impart some evidence for the hypoarousal model of alexithymia during reactivity, but the hyperarousal model during recovery. Autonomic dysregulation during and following acute emotional stress is suggested as a possible physiological pathway connecting alexithymia to cardiovascular disease.

The effect of exposure to negative air ions on the recovery of physiological responses after moderate endurance exercise.

This study examined the effects of negative air ion exposure on the human cardiovascular and endocrine systems during rest and during the recovery period following moderate endurance exercise. Ten healthy adult men were studied in the presence (8,000-10,000 cm-3) or absence (200-400 cm-3) of negative air ions (25 degrees C, 50% humidity) after 1 h of exercise. The level of exercise was adjusted to represent a 50-60% load compared with the subjects' maximal oxygen uptake, which was determined using a bicycle ergometer in an unmodified environment (22-23 degrees C, 30-35% humidity, 200-400 negative air ions.cm-3). The diastolic blood pressure (DBP) values during the recovery period were significantly lower in the presence of negative ions than in their absence. The plasma levels of serotonin (5-HT) and dopamine (DA) were significantly lower in the presence of negative ions than in their absence. These results demonstrated that exposure to negative air ions produced a slow recovery of DBP and decreases in the levels of 5-HT and DA in the recovery period after moderate endurance exercise. 5-HT is thought to have contributed to the slow recovery of DBP.

Cardiovascular recovery from stress and hypertension risk factors: a meta-analytic review.

Recent research has suggested that cardiovascular recovery from stress can play a potential role in hypertension pathogenesis. Sixty-nine studies were included in a meta-analytic review to evaluate the effect of various hypertension risk factors (e.g., race, lack of exercise) on cardiovascular recovery from stress. Small mean effect sizes were observed for studies examining hypertension status and race as risk factors associated with delayed diastolic blood pressure recovery. Lack of fitness was also associated with delayed heart rate recovery. These results revealed that, for the specified risk factors and cardiovascular variables, high-risk individuals exhibited delayed cardiovascular recovery as compared with low-risk individuals. Further, the relationships between hypertension status, race, and cardiovascular recovery were typically associated with the use of "active" laboratory stressors. The relationship between lack of fitness and cardiovascular recovery was also associated with the use of "active" and exercise laboratory stressors.

Contribution of humoral systems to the recovery of blood pressure following severe haemorrhage.

1. Profound haemorrhage activates a number of pressor mechanisms, including the release of catecholamines, angiotensin II and arginine-vasopressin, which contribute to the subsequent cardiovascular recovery. Using specific single or combined blockade with prazosin, losartan and Manning compound (AVPX), the aim of this study was to evaluate the involvement of the three pressor systems in blood pressure recovery following severe haemorrhage (20 ml kg-1). 2. Haemorrhage of conscious, unrestrained rats resulted in a significant initial decrease in blood pressure of approximately 60 mmHg, and heart rate of approximately 70 bpm. Then, blood pressure tended to return to the control level within 10 min. The total cardiovascular recovery corresponded to increments of 52 +/- 5 mmHg (81% of the acute fall) for systolic blood pressure, and of 92 +/- 22 bpm (124%) for heart rate at 60 min post-bleeding. Significant falls in haematocrit (-10.5 +/- 1.2%, P < 0.01), in plasma concentrations of proteins (-10.3 +/- 0.9 g l-1, P < 0.01) and haemoglobin (-2.58 +/- 0.72 g 100 ml-1, P < 0.05) were observed at 60 min post-bleeding. 3. Pretreatment with one or two specific antagonists did not exaggerate the initial fall in blood pressure. The initial bradycardia was weakened only by combined blockade with losartan and AVPX. 4. The blood pressure recovery from a haemorrhage was delayed by approximately 25 min by the inhibition of vasopressin activity. The systolic blood pressure recovery in control animals (81% of the acute fall) was blunted by losartan (55% of the acute fall), prazosin (49%), combined losartan and AVPX (36%), prazosin and AVPX (36%), and also by prazosin plus losartan (13%). The diastolic blood pressure recovery was blunted only in the groups where the activity of angiotensin II was inhibited by losartan. 5. In conclusion, we have shown that neither catecholamines, angiotensin II nor vasopressin, although activated, individually compensate the acute hypotensive response to haemorrhage. The contribution of vasopressin to the blood pressure recovery post-bleeding is transient and is rapidly replaced by the pressor activity of the catecholamines and angiotensin II. The full systolic blood pressure recovery from severe haemorrhage requires the combined activity of these two pressor systems, while the diastolic blood pressure recovery seems to be only dependent upon angiotensin II activity.

Race and sex differences in cardiovascular recovery from acute stress

To evaluate the effects of race and gender on recovery, i.e. the relative return to baseline after a stress challenge, cardiovascular and catecholamine measures were examined before, during, and after two standardized laboratory Stressors (a speaking and a mirror tracing task) in a group of 85 Black and White men and women (mean age 35.6 years, range 20 to 52). For the speech task, White men showed the least systolic ( p < 0.025) and diastolic ( p < 0.05) blood pressure recovery as compared to Black men and women. For the mirror star tracing task, total peripheral resistance ( p < 0.03) recovery was least for Whites as compared to Blacks and heart rate ( p < 0.04) recovery was least for White women as compared to Black women and men. There were no significant group effects in terms of catecholamine recovery from either task. The findings extend prior studies on race and gender by suggesting that these same characteristics affect recovery from Stressors.

The psychobiology of hostility: Possible endogenous opioid mechanisms

This study examined the role of endogenous opioids in the relation between hostility and cardiovascular stress responsiveness. Forty-six men completed the Cook-Medley Hostility Scale and experienced a laboratory pain stressor once under opioid blockade and once under placebo. Hostility scores were significantly related to the magnitude of change in cardiovascular reactivity/recovery resulting from opioid blockade. Low scorers on the Cynicism subscale displayed increases in heart rate (HR) reactivity under blockade relative to placebo, with reactivity decreases noted in high scorers. Low Hostile Affect scores were similarly associated with impaired diastolic blood pressure recovery under opioid blockade. HR recovery results were somewhat different, with high scorers on Aggressive Responding and the total Cook-Medley displaying improved HR recovery under opioid blockade, with no change noted in low scorers. These data provide preliminary support for the hypothesis that low hostile individuals rely on endogenous opioids for buffering cardiovascular stress responsiveness, but high hostiles do not.

Left ventricular hemodynamics during exercise recovery

The directional response of human left ventricular stroke volume during exercise recovery is unclear. Stroke volume has been reported to increase and decrease over exercise values during early recovery. The confounding variable may be posture. With the use of pulsed Doppler ultrasound, we tested the hypothesis that there is a significant difference between seated and supine stroke index (SI) during passive recovery from seated ergometer exercise. Thirteen subjects aged 26 +/- 2 yr performed two seated cycle ergometer exercise tests to 70% of predicted maximum heart rate (HR). Recovery was supine on one test and seated on the other. Cardiac index (CI), HR, and SI were calculated during rest, exercise, and 10 min of recovery. At rest, SI and CI were significantly (P less than 0.01) less and HR significantly (P less than 0.01) greater when the subjects were seated than when they were supine. At the last exercise work load, no significant differences were found in any measured variable between tests. During recovery, supine SI was maximal 180 s postexercise (99 +/- 14 ml/m2) and exceeded (P less than 0.01) resting supine (81 +/- 14 ml/m2) and peak exercise (77 +/- 14 ml/m2) SI by 22 and 29%, respectively. Seated SI was constant at peak exercise levels for 2 min. Seated and supine recovery CI never exceeded exercise values. Systolic and diastolic blood pressure recovery curves were similar in the two postures. We conclude that posture significantly affects SI during recovery from submaximal seated exercise. These results have implications for choice of recovery posture after stress testing in cardiac patients where it is desirable to minimize ventricular loading.

Heart rate and blood pressure reactivity during active coping with a mental task in healthy 18- to 73-year-old subjects.

Alterations with aging in the responses of heart rate (HR) and blood pressure (BP) reactivity were investigated during mild mental stress induced by undergoing a psychometric test, in 52 women and men aged 18-73 years, with no history of cardiovascular, renal or neurological deficits. HR and BP responses were measured before, during and after the test. Resting HR and diastolic BP (DBP) were not age-related while resting systolic BP (SBP) was. HR and SBP were increased during test performance. HR reactivity, measured during task execution as well as during recovery, was significantly decreased in older subjects. DBP recovery variation was lowered with age. These results indicate that age is an important determinant of the magnitude of cardiovascular adjustment during minor mental stress in women and men.

Cardio-respiratory fitness of young and older active and sedentary men.

Physiological profiles are described for 30 healthy young (20-31 years) and 30 healthy older (50-62 years) men. Half of the individuals in each group reported that during the previous five years they participated frequently in strenuous physical exercises; the other half reported sedentary lifestyles. A treadmill exercise test was used to determine maximal aerobic power (VO2 max). Heart rate and blood pressure were measured during rest, maximal exercise and recovery. The active older men demonstrated significantly lower resting heart rates, lower resting systolic and diastolic blood pressures, higher VO2 max, lower maximal exercise diastolic blood pressure and lower recovery heart rates than the age-matched sedentary men. Compared with the young sedentary men, the older active men had lower resting heart rates and higher VO2 max, walked longer on the treadmill, had lower recovery heart rates and weighed less. Older active men also had higher VO2 max levels than young sedentary men. In summary, physiological profiles of the older active men more closely resembled profiles of active men who were 30 years younger than those of older sedentary men. These results emphasize the range of benefits associated with exercise.

Predictors of Stable Hypertension in Young Borderline Subjects: A Five-Year Follow-Up Study

Forty-four young subjects with borderline hypertension underwent a 5-year follow-up. At the first examination their intralymphocytic Na+ (Nai) was measured before and after 1 month of a low-salt diet. Blood pressure and heart rate were recorded at rest (baseline), during mental arithmetic, and after the test (recovery). After 5 years, no subject with normal Nai developed hypertension, and, furthermore, subjects with normal Nai had no increase in blood pressure values. Thirty-one percent of subjects with high Nai developed hypertension. Subjects developing hypertension were characterized by a high pressor response to mental stress and by an increase in recovery diastolic blood pressure in comparison with baseline diastolic blood pressure. Sixty percent of the subjects whose recovery diastolic blood pressure was at least 6% higher than baseline developed hypertension. Eighty percent of subjects whose Nai was not reduced after the diet became hypertensive. Nai and diastolic blood pressure were unrelated at the first examination; however, a significant correlation was found between Nai recorded at first examination and diastolic blood pressure recorded after 5 years. It is concluded that Nai is a good predictor of future blood pressure in borderline subjects and that subjects with normal Nai have a very low risk of developing high blood pressure.

A Physiological Comparison of Static and Phasic Exercise

Abstract Five subjects were tested three times in each of three static and three phasic work tests involving leg extensions in the semi-reclining position. Oxygen uptake, net oxygen consumption, ventilation rate, pulse rate, and systolic and diastolic blood pressures were consistently higher in phasic work than in static effort with a comparable resistance. The patterns of systolic and diastolic blood pressure and pulse rate response and recovery did not seem to differ in the two modes of work. While the ventilation rate—oxygen uptake relationship was similar in both forms of effort, the pulse rate—oxygen uptake relationship differed in that the static pulse exceeded the phasic rate at a comparable level of oxygen uptake.