Higher Blood Pressure Response Research Articles

Exaggerated Blood Pressure Response to Exercise Is a Risk of Future Hypertension Even in Healthy, Normotensive Young Individuals—Potential Preventive Strategies for This Phenomenon?

Physical activity and regular exercise are well known to reduce the risks of cerebrovascular and cardiovascular diseases, leading the American College of Sports Medicine to endorse the concept that “exercise is medicine”. However, a single bout of exercise temporarily raises arterial blood pressure (BP) to meet the metabolic demands of working muscle, and this BP response is particularly exaggerated in older adults and patients with cardiovascular conditions, such as hypertension, resulting in an exaggerated BP response during exercise. This presents a paradox: while regular exercise is crucial for preventing these diseases, excessively high BP responses during exercise could increase the risk of vascular damage. The mechanisms underlying this exaggerated BP response during exercise remain unclear, and effective exercise regimens for these populations have yet to be established. Currently, low-intensity exercise is recommended; however, its efficacy in disease prevention is uncertain. Notably, even among healthy individuals, there is significant variation in the BP response to exercise. Some healthy individuals, despite having normal resting BP, exhibit an exaggerated BP response during physical activity. Importantly, these individuals are often unaware that their BP becomes excessively elevated during physical activity. Repeated exposure to these heightened BP responses through regular physical activity may increase their long-term risk of cardiovascular disease. How can we prevent disease development in these individuals while still ensuring the effectiveness of exercise? Some studies have shown that individuals with a family history of hypertension may experience this phenomenon even in children and adolescents. Additionally, left ventricular hypertrophy contributes to an exaggerated BP response to exercise, suggesting a possible genetic influence. Conversely, other reports indicate that factors such as arterial stiffness, obesity, and low exercise capacity also contribute to this exaggerated response. Our recent preliminary data suggest that the cognitive benefits of exercise may be diminished in individuals who exhibit an exaggerated BP response during exercise. This implies that individuals with an exaggerated BP response, despite having normal resting BP, may not fully benefit from exercise. In this perspective paper, we review the physiological aspects of this phenomenon and explore strategies to address it. Additionally, we discuss BP responses in athletes within this content. Our goal is to prevent disease while maximizing the benefits of exercise for healthy individuals with an exaggerated BP response, as well as for elderly and cardiovascular patients.

Blunted Brachial Blood Flow Velocity Recovery to Acute Mental Stress in Young Women with PTSD Compared to Controls

Introduction: Post-traumatic stress disorder (PTSD) is a debilitating mental illness associated with increased cardiovascular disease (CVD) risk, a major cause of death among women in the United States. Women are twice as likely as men to develop PTSD after trauma exposure, and cardiovascular reactivity to stress is a known risk factor for CVD. Therefore, our aim was to investigate if young women diagnosed with PTSD will present with impaired hemodynamic responses to acute stress compared to controls. We hypothesized that women with PTSD will have high blood pressure (BP), heart rate (HR) and blood flow velocity (BFV) response to a mental stress protocol, and a blunted recovery. Methods: We recruited for this study ten young women with PTSD and nine trauma-exposed women without PTSD (controls) between the ages of 18 to 40 years. We collected data in a single laboratory visit after informed consent and PTSD symptoms severity questionnaire. After demographics and resting hemodynamics, we continuously measured HR using a three-lead EKG, beat-to-beat BP using finger plethysmography and continuous brachial BFV using Doppler ultrasound. A Doppler audio translator was used to transfer the doppler signal in our data analysis software for simultaneous recording of all hemodynamics variables. All variables were recorded during 5 min of supine rest, 5 min of mental stress (via mental arithmetic) and 5 min of recovery. The response and recovery to stress was analyzed using an analysis of covariance with timepoint as within factor and PTSD diagnosis as between-factor. Results: Women with a clinical diagnosis of PTSD had a mean age of 27±10 years and body mass index (BMI) of 30.1±2.9 kg/m2. Controls (trauma-exposed women without PTSD) had a mean age of 26±7 years and body mass index (BMI) of 24± 2.1 kg/m2. Resting seated BP and HR were not different between the groups. The slopes of the overall changes in BFV from baseline to mental stress to recovery were different between young women with PTSD and controls (timepoint*group, P= 0.057) when controlling for PTSD symptoms severity. Specifically, although mental stress elicited similar increases in BFV in women with PTSD (Δ0.80±1.8 cm/sec) and in controls [Δ0.45±1.2 cm/sec, P= 0.44 (timepoint*group)], BFV recovery from stress was impaired in PTSD (Δ0.64±1.3 cm/sec), but not in controls [Δ-2.20±0.84 cm/sec, P= 0.047 (timepoint*group)]. BP and HR reactivity to mental stress and recovery were not different between the groups (P>0.05). Conclusion: The current pilot study revealed that PTSD is associated with blunted recovery from acute mental stress, suggesting early impairment of vascular function in these women at a young age. Young pre-menopausal women are overlooked in prevention strategies and health policies targeting populations at-risk for CVD; with the rising prevalence of trauma exposure in young women, evidence is pointing to a parallel increase in CVD risk. K01HL161027 and UMN CTSI UL1TR002494 No Disclosure. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Identifying Who Benefits the Most from a Community Health Worker-Led Multicomponent Intervention for Hypertension.

Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equally effective across participant subgroups is unknown. To identify participants who benefit the most from the HCPIA BP control intervention. This secondary analysis used data from HCPIA, a successful 18-month cluster-randomized trial in 18 health centers with 1,432 low-income hypertensive patients in Argentina. Fifteen baseline characteristics were used to define subgroups. The proportion of controlled BP (<140/90 mmHg) was estimated using generalized linear mixed models with arm-by-subgroup interaction terms. The distribution of trial BP response among intervention patient subgroups was assessed. Participants were 53.0% female, a mean age of 56 years, and 17.4% controlled BP at baseline. After the intervention, 72.9% of intervention and 52.2% of control participants had controlled BP. The intervention was more effective in physically inactive patients (OR = 2.76, 95% CI: 1.82 and 4.21; p for interaction = 0.04), moderately active patients (OR = 3.08, 95% CI: 1.90 and 4.99; p for interaction = 0.03), and those with uncontrolled BP at baseline (OR = 2.77, 95% CI: 2.15 and 3.57; p for interaction = 0.05). Among intervention participants, 20.2% had no BP response (BP change < -4 mmHg), 41.3% had a moderate BP response (BP change: -4 mmHg to -24 mmHg), and 38.5% had a high BP response (BP change > -24 mmHg). Women (p=0.01), those who were physically inactive (p=0.03), and those not taking antihypertensive medications at baseline (p=0.001) had the greatest BP response. The effect of the intervention was consistent across many subgroups with some key groups showing a particularly strong intervention effect. These findings could be useful for planning future hypertension control programs in low- and middle-income countries.

Effect of COVID-19 on Blood Pressure Profile and Oxygen Pulse during and after the Cardiopulmonary Exercise Test in Healthy Adults.

Several reports have shown the impact of COVID-19 history on exercise capacity. This study compared the blood pressure (BP) response and oxygen pulse (O2 pulse) characteristics in normotensive patients with and without a history of COVID-19 during the cardiopulmonary exercise test (CPET) and post-exercise recovery. This cross-sectional study involved 130 healthy Caucasian adult volunteers (71 participants with a history of COVID-19). All patients underwent the CPET with blood pressure measurements during exercise and post-exercise recovery. The post-COVID group had significantly higher systolic, diastolic, and mean blood pressure after 9 min of recovery and achieved a significantly lower max O2 pulse (2.02 mL/beat on average) than the controls. It should be noted that the COVID group tended to have higher blood pressure values in all steps, with no differences in heart rate, pulse pressure, and saturation at any step. The COVID-19 outbreak was associated with a higher blood pressure response, significantly, in post-exercise recovery, a lower maximum O2 pulse, and a lower maximum load achievement. Future studies are needed to determine if these abnormalities during the CPET and the blood pressure variation have prognostic value.

The Relationship Between the Frontal QRS-T Angle and High Blood Pressure Response to Exercise

The Relationship Between the Frontal QRS-T Angle and High Blood Pressure Response to Exercise

Abstract 11503: Obesity-Related Biomarkers Associations With HFpEF and Exercise Intolerance

Background: Obesity and adiposity are associated with risk of heart failure with preserved ejection fraction (HFpEF), yet the role of adipokines and other obesity related pathways as contributors to HFpEF remains unclear. Objectives: We sought to examine the association of obesity and obesity related biomarkers including adipokines, inflammatory markers, and insulin resistance with HFpEF and specific cardiac and extracardiac organ reserve measures among patients who underwent CPET. Methods: We studied 509 consecutive patients with LVEF ≥ 50% and NYHA class II - III symptoms, who underwent clinically indicated CPET with invasive hemodynamic monitoring. Fasting blood samples at the time of CPET were used to assay obesity-related biomarkers, including leptin, adiponectin, resistin, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), glucose and insulin to estimate insulin resistance (HOMA-IR). We examined the association of biomarkers with physiologic HFpEF and exercise traits using multivariable regression models. Results: Among 509 patients (mean age 55 years, 61% women, 38% obese), 223 met hemodynamic criteria for HFpEF. Obesity was associated with more than 2-fold higher odds of HFpEF (OR 2.08, 95% CI 1.38-3.14). We found that higher levels of leptin, hsCRP and HOMA-IR were associated with greater odds of HFpEF (P ≤ 0.01, Figure 1). By contrast, resistin and adiponectin were not associated with HFpEF (P&gt;0.05). In secondary analyses, we observed associations of obesity related biomarkers with measures of impaired exercise capacity, such as lower peak VO 2 (P&lt;0.05), higher blood pressure response (leptin, HOMA-IR), and impaired heart rate response (hsCRP, HOMA-IR, IL-6, resistin). Conclusions: Obesity related biomarkers were associated with HFpEF and impaired exercise capacity. These findings highlight potential pathways underlying the association of obesity and cardiometabolic disease with development of HFpEF.

Blood Pressure Response and Pulse Arrival Time During Exercise Testing in Well-Trained Individuals.

Introduction: There is a lack of data describing the blood pressure response (BPR) in well-trained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing. Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a non-invasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests. Results: At lactate threshold (281 ± 56 W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r 2 of 0.81 ± 17. Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing.

Cardiovascular reactivity, stress, and personal emotional salience: Choose your tasks carefully.

Both greater cardiovascular reactivity and lesser reactivity ("blunting") to laboratory stressors are linked to poor health outcomes, including among people who have a history of traumatic experiences. In a sample of recently separated and divorced adults (N=96), this study examined whether differences in cardiovascular reactivity might be explained by differences in the personal emotional salience of the tasks and trauma history. Participants were assessed for trauma history, current distress related to their marital dissolution, and cardiovascular reactivity during two tasks, a serial subtraction math stressor task and a divorce-recall task. Participants with a greater trauma history evidenced less blood pressure reactivity to the serial subtraction task (a low personal emotional salience task) when compared to participants with less trauma history. In contrast, participants with a greater trauma history evidenced higher blood pressure reactivity to the divorce-recall task, but only if they also reported more divorce-related distress (high personal emotional salience). These associations were not significant for heart rate reactivity. Among people with a history of more traumatic experiences, a task with low personal salience was associated with a lower blood pressure response, whereas a task with higher personal emotional salience was associated with a higher blood pressure response. Future studies examining cardiovascular reactivity would benefit from determining the personal emotional salience of tasks, particularly for groups that have experienced stressful life events or trauma.

Evaluation of the intervention of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Abstract Objective Chronic obstructive pulmonary disease (COPD) can be prevented and treated, although presenting with persistent airflow restriction; the airflow restriction caused by COPD is mostly progressive. In recent years, more attention has been paid to the home-based pulmonary rehabilitation (PR) and its influence on COPD. Exercise training is the basic constituent of PR. However, it is not clear which exercise trainings are the ideal ways to deliver home-based PR. Methods In this review, we focus on the effect of home-based exercise training on patients with COPD. We searched literature, which was necessarily required to be randomized controlled trails (RCTs) from the establishment of the four respective databases (Medline, PubMed, Web of Science, and China National Knowledge Infrastructure) from January 2008 to January 2018. We used the Cochrane collaborative “risk of bias” tool to assess the quality of evidence. A total of 21 trials (1694 participants) were included. Through the analysis of the literature, we find that a simple, low-cost, and low-intensity family-based lung-rehabilitation plan to adapt to the real life may lead to the improvement of the ability to exercise, the reduction of the difficulty in breathing, and the improvement of carrying out daily activities. Results In the exercise training of home-based PR, lower limb exercise (LLE) training demonstrated a more perceptible effect in improving the quality of life of patients with COPD. At the same time, the combination of LLE training, breathing training, and upper limb exercise training is more obvious than the simple LLE training. In addition, home-based low-intensity aerobic training may sometimes be no less than the outpatient or center intervention to improve dyspnea, health status, and exercise tolerance. In conclusion, the simple and easy home-based PR exercise program is useful. Long-term home-based PR may require an enhanced need for maintenance. Conclusions A simple, low-cost, and low-intensity high blood pressure response (HBPR) plan to adapt to the real life may lead to an augmentation in the ability to exercise, a reduction of the difficulty in breathing, and an improvement in carrying out day-to-day activities. HBPR strategies can benefit patients (elderly patients with COPD at home) in the long term.

Skeletal Muscle Reflex‐Induced Dysregulation of Sympathetic Nerve Activity in Type 1 Diabetic Rats

The pressor response to physical exercise is exaggerated in the early stages of type 1 diabetes mellitus (T1DM). This augmented blood pressure (BP) response has been further shown to be mediated by an overactive skeletal muscle exercise pressor reflex (EPR). However, whether alterations in sympathetic responsiveness contribute to this EPR overactivity is unknown. The purpose of this study was to test the hypothesis that the potentiated BP response to exercise in T1DM is mediated by EPR‐induced sympathetic overactivity. Sprague‐Dawley rats were intraperitoneally given either 50 mg/kg streptozotocin (T1DM) or saline (control). We measured renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) responses to activation of the EPR, as well as its functional components, the mechanoreflex and metaboreflex, in decerebrate animals at 1–3 weeks after administration. Compared to control rats, selective activation of the EPR evoked significantly greater increases in RSNA (Δ = 58±7 vs. 96±15 %, P&lt;0.05) and MAP (Δ = 11±2 vs. 33±5 mmHg, P&lt;0.05) in T1DM rats. The sympathetic and pressor responses to the individual stimulation of the mechanoreflex and metaboreflex were also significantly larger in T1DM animals than in control animals (P&lt;0.05). These findings suggest that in untreated T1DM, abnormally large muscle reflex‐evoked sympathetic overactivity contributes significantly to exaggerations in BP during exercise. Importantly, the results implicate sympathetic overactivity as a potential therapeutic target for improving/preventing the abnormally high BP response to exercise in T1DM.Support or Funding InformationThe Southwestern School of Health Professions Interdisciplinary Research Grant Program, the Lawson &amp; Rogers Lacy Research Fund in Cardiovascular Disease and the JSPS KAKENHI JP17K01769

The Effect of BML-111 in Preeclampsia Rat Model Induced by the Low Dose of Cadmium Chloride.

Aim This article determines the optimal time and dose of cadmium chloride (CdCl 2 ) injected to pregnant rat to establish experimental preeclampsia (PE) model. In addition, the therapeutic potential of BML-111, a lipoxin A4 analogue, in the CdCl 2 -induced PE model was also evaluated. Methods Peritoneal injection of two dose of CdCl 2 for successive 6 days was tested in the pregnant rats starting from various gestational days (GDs). During this process, the systolic blood pressure and the body weight of pregnant rats and neonatal rats were monitored. The pathological changes of the placenta and kidney were evaluated by hematoxylin and eosin staining. The phosphorylation of extracellular signal-regulated kinase 1/2 and signal transducer and activator of transcription 3 in the placentas was detected by Western blot, and the messenger ribonucleic acid expression of interleukin (IL)-6, tumor necrosis factor-α, and IL-10 in the placentas were detected by real-time polymerase chain reaction. BML-111 at the dose of 1 mg/kg/day was peritoneally injected into the rat after establishing the PE model to test its therapeutic potential. Results In the present study, we successfully established the PE model in pregnant rats by intraperitoneally injection of CdCl 2 at the dose of 0.125 mg/kg/day from GD 9 to 14. We recapitulated multiple features of clinical PE in CdCl 2 -induced rat, including high blood pressure, renal dysfunction, and inflammatory response in placenta. Furthermore, treatment with BML-111 significantly relieved multiple features in our PE rat model. Conclusions BML-111 has a potential therapeutic effect in pregnant rats with CdCl 2 -induced PE, which appears to be mediated through inhibition of inflammatory processes in the placenta.

High blood pressure response to exercise predicts future development of hypertension in young athletes

Due to superior exercise performance, athletes show higher blood pressure (BP) at peak exercise compared to untrained individuals. Thus, higher reference values for peak exercise systolic and diastolic BP were reported specifically for athletes. However, the prognostic significance of high blood pressure response (HBPR) to exercise has not yet been clarified in this population. One hundred and forty-one normotensive athletes with HBPR to exercise were compared to 141 normotensive athletes with normal blood pressure response (NBPR) to exercise, matched for gender, age, body size, and type of sport. All athletes were followed up for 6.5 ± 2.8 years. Over follow-up, no cardiac events occurred; 24 athletes were diagnosed essential hypertension (8.5%). Specifically, 19 (13.5%) belonged to the HBPR compared with 5 (3.5%) in the NBPR group (P = 0.003). Kaplan-Meier analysis confirmed that the incidence of hypertension during follow-up was higher in the HBPR group (log-rank χ2P-value = 0.009). Multivariable analysis by Cox proportional hazard survival model showed that resting BP and HBPR at baseline evaluation were the strongest predictors of incident hypertension (χ2 for the model 30.099; P < 0.001). Specifically, HBPR was associated with a hazard ratio of 3.6 (95% confidence interval 1.3-9.9) of developing hypertension. Over follow-up exercise capacity, as well as morphologic and functional cardiac parameters in athletes from both groups did not change significantly. The present study showed that an exaggerated BP response to exercise increased the risk for incident hypertension in highly trained and normotensive athletes over a middle-term period.

Blood Pressure Response to Exercise and Cardiovascular Disease.

This review aimed to provide a clinical update on exercise blood pressure (BP) and its relationship to cardiovascular disease (CVD), outlining key determinants of abnormal exercise BP responses. We also highlight current evidence gaps that need addressing in order to optimise the relevance of exercise BP as clinical CVD risk factor. Abnormal exercise BP manifests as either exercise hypotension (low BP response) or as exaggerated exercise BP (high BP response). Exercise hypotension is an established sign of existing and likely severe CVD, but exaggerated exercise BP also carries elevated CVD risk due to its association with sub-clinical hypertension. Although exaggerated exercise BP is related to heightened CVD risk at any exercise intensity, recent data suggest that the BP response to submaximal intensity exercise holds greater prognostic and clinical significance than BP achieved at peak/maximal intensity exercise. Cardiorespiratory fitness is a strong modifier of the exercise BP response, and should be taken into consideration when assessing the association with CVD. Both exercise hypotension and exaggerated exercise BP serve as markers that should prompt evaluation for potential underlying CVD. However, the clinical utility of these markers is currently inhibited by the lack of consensus informing the definitions and thresholds for abnormalities in exercise BP.

Blood pressure and calf muscle oxygen extraction during plantar flexion exercise in peripheral artery disease.

Peripheral artery disease (PAD) is an atherosclerotic vascular disease that affects 200 million people worldwide. Although PAD primarily affects large arteries, it is also associated with microvascular dysfunction, an exaggerated blood pressure (BP) response to exercise, and high cardiovascular mortality. We hypothesized that fatiguing plantar flexion exercise that evokes claudication elicits a greater reduction in skeletal muscle oxygenation (SmO2) and a higher rise in BP in PAD compared with age-matched healthy subjects, but low-intensity steady-state plantar flexion elicits similar responses between groups. In the first experiment, eight patients with PAD and eight healthy controls performed fatiguing plantar flexion exercise (from 0.5 to 7 kg for up to 14 min). In the second experiment, seven patients with PAD and seven healthy controls performed low-intensity plantar flexion exercise (2.0 kg for 14 min). BP, heart rate (HR), and SmO2 were measured continuously using near-infrared spectroscopy (NIRS). SmO2 is the ratio of oxygenated hemoglobin to total hemoglobin, expressed as a percent. At fatigue, patients with PAD had a greater increase in mean arterial BP (18 ± 2 vs. vs. 10 ± 2 mmHg, P = 0.029) and HR (14 ± 2 vs. 6 ± 2 beats/min, P = 0.033) and a greater reduction in SmO2 (-54 ± 10 vs. -12 ± 4%, P = 0.001). However, both groups had similar physiological responses to low-intensity, nonpainful plantar flexion exercise. These data suggest that patients with PAD have altered oxygen uptake and/or utilization during fatiguing exercise coincident with an augmented BP response.NEW & NOTEWORTHY In this laboratory study, patients with peripheral artery disease performed plantar flexion exercise in the supine posture until symptoms of claudication occurred. Relative to age- and sex-matched healthy subjects we found that patients had a higher blood pressure response, a higher heart rate response, and a greater reduction in skeletal muscle oxygenation as determined by near-infrared spectroscopy. Our data suggest that muscle ischemia contributes to the augmented exercise pressor reflex in peripheral artery disease.

Upper normal values of blood pressure response to exercise in Olympic athletes

Exercise test is widespread performed in athletes to assess cardiovascular adaptations during effort; however, scarce information exists relative to the behavior of blood pressure during exercise in athletes. We sought to define the normal values and upper limits of blood pressure response to exercise in a large population of elite, healthy athletes. A total of 1,876 healthy, normotensive elite athletes (aged 25 ± 6 years, 64% male) underwent a comprehensive clinical evaluation including maximal bicycle exercise test. At maximum exercise, the systolic blood pressure increased significantly (Δ = +69 ± 18 mm Hg; P< .001), whereas diastolic blood pressure showed minimal change (Δ = +1 ± 7 mm Hg; P= .001). The upper reference values were 220 mm Hg in male and 200 mm Hg in female athletes for systolic blood pressure, and 85 mm Hg in male and 80 mm Hg in female for diastolic blood pressure. A subgroup of 142 athletes (7.5%) showed high blood pressure response to exercise, that is, increase in systolic and/or diastolic blood pressure above the 95th percentile. Multivariate logistic regression analysis showed that endurance and mixed sport disciplines, body mass index, and baseline systolic blood pressure were the strongest determinants for high blood pressure response to exercise. The gender-specific reference values for systolic and diastolic blood pressure at maximum exercise in athletes were defined. A small subset (7.5%) of athletes showed higher blood pressure response, in the absence of target organ disease or metabolic abnormalities, and associated with superior physical performance and larger cardiac remodeling.

Effect of hypertension at presentation on prognosis in patients with dilated cardiomyopathy presenting with normal renal angiogram.

Background & objectives:Dilated cardiomyopathy (DCM) is a progressive disease of heart with systolic and diastolic dysfunction carrying a poor long-term prognosis. The prognostic index and predictors of mortality are considered to be useful in guiding the treatment. This study was undertaken to evaluate the effects of hypertension at presentation on prognosis in patients with DCM presenting with normal renal and coronary angiogram.Methods:An observational, analytical, non-interventional and a combination of retrospective and prospective study was conducted in patients between 15 and 75 yr of age with DCM having on and off symptoms while receiving treatment in a cardiology outpatient department for more than a year. Sixty patients who fulfilled the inclusion criteria were enrolled in the study. Left ventricular systolic and diastolic functions were assessed by echocardiography along with New York Heart Association (NYHA) functional class prospectively and at baseline retrospectively. Patients were grouped into two categories: DCM with hypertension at presentation (HTNAP, Category 1) and DCM without hypertension at presentation (NHTNAP, Category 2). The primary end-points were the number and dose of parenteral drugs at hospitalization, duration of hospital stay and change in the left ventricular (LV) systolic function expressed as LV ejection fraction, and the secondary end-points included overall mortality, change in LV and right ventricular systolic and diastolic functions and change in the NYHA functional class between baseline and three month follow up in patients.Results:Thirty five and 25 patients presented with HTNAP and NHTNAP, respectively (total 60). The overall mortality was 10 per cent (6/60). The number of hospitalizations was less in HTNAP category and of days of hospital stay was 6.3 in HTNAP and 9.8 in NHTNAP, the difference being significant (P < 0.001). The HTNAP category required less parenteral diuretics and inotropes compared with the NHTNAP category. The echocardiographic parameters showed better improvements in the HTNAP group as compared to the NHTNAP group. Overall, the patients in the <35 yr of age showed the best prognosis (P < 0.001).Interpretation & conclusions:Normal or high blood pressure response at acute presentation of DCM leads to better prognosis which may be due to an intact renovascular and an active sympathetic system and can depict the stage of DCM.

Autoimmunity in the Pathogenesis of Hypertension

I want to express my thanks for being selected to present the 2015 Lewis K. Dahl Lecture. This award has a long and proud tradition in the hypertension field, and the list of previous awardees is so impressive that finding myself in their company is an honor indeed. The groundbreaking research of Lewis Kitchener Dahl on the role of salt and genetics in hypertension originated in his earlier interest on the relationship between salt intake and blood pressure,1 and his best known contribution, the salt-resistant and salt-sensitive rat strains,2,3 have been and will continue to be used in hypertension research all over the world. At present, the Dahl’s salt-sensitive (SS) rat is used to examine the genetic characteristics of hypertension using targeted mutagenesis of genes associated with human hypertension.4 Yet, among Dr Dahl’s many seminal contributions, I, as a nephrologist, have a predilection for his studies of cross-transplantation of kidneys between salt-sensitive and salt-resistant rats showing that the high blood pressure and normal blood pressure responses to a high-salt diet travel with the kidney5,6 because these experiments demonstrated that the kidney had a central role in the pathogenesis of hypertension. Less cited among their works, Lewis Dahl and his coworkers also made observations on the histological findings in the kidneys that are of particular relevance to the subject of this conference. They reported that renal lesions did not occur in R (resistant) rats on either diet, were minimum to mild in S (sensitive) rats on the diet low in salt, and were moderate to severe in S rats on the diet high in salt.7 I will take these observations as the starting point to review the evidence that renal inflammation is a key element in the role of the kidney in …

Comparison of Myocardial Ischemia During Intense Mental Stress Using Flight Simulation in Airline Pilots With Coronary Artery Disease to That Produced With Conventional Mental and Treadmill Exercise Stress Testing

Mental stress increases cardiovascular morbidity and mortality. Although laboratory mental stress often causes less myocardial ischemia than exercise stress (ES), it is unclear whether mental stress is intrinsically different or differences are due to less hemodynamic stress with mental stress. We sought to evaluate the hemodynamic and ischemic response to intense realistic mental stress created by modern flight simulators and compare this response to that of exercise treadmill testing and conventional laboratory mental stress (CMS) testing in pilots with coronary disease. Sixteen airline pilots with angiographically documented coronary disease and documented myocardial ischemia during ES were studied using maximal treadmill ES, CMS, and aviation mental stress (AMS) testing. AMS testing was done in a sophisticated simulator using multiple system failures as stressors. Treadmill ES testing resulted in the highest heart rate, but AMS caused a higher blood pressure response than CMS. Maximal rate-pressure product was not significantly different between ES and AMS (25,646 vs 23,347, p = 0.08), although these were higher than CMS (16,336, p <0.0001). Despite similar hemodynamic stress induced by ES and AMS, AMS resulted in significantly less ST-segment depression and nuclear ischemia than ES. Differences in induction of ischemia by mental stress compared to ES do not appear to be due to the creation of less hemodynamic stress. In conclusion, even with equivalent hemodynamic stress, intense realistic mental stress induced by flight simulators results in significantly less myocardial ischemia than ES as measured by ST-segment depression and nuclear ischemia.

Hypertensive response to exercise: a marker of altered metabolism in endurance athletes?

BackgroundInappropriate high blood pressure response to exercise in non athletes is known to be a predictor for future resting systemic hypertension. However, the relevance of exercise hypertension in endurance athletes...

Non-Hypertensive Patients with Prolonged P-Wave Indices Have Higher Blood Pressure Response to Exercise Stress Test

Background/Objectives: Hypertension during exercise has been linked to future hypertension. Prolonged P-wave indices (PWI) has also been associated with prehypertension. We aim to compare exercise stress test parameters in non-hypertensives with normal and prolonged PWI. Methods: Non-hypertensive patients above 18 years without known heart disease and negative ECG stress test were studied. 12-lead ECG at a paper speed of 25 mm/s and 1 mV/cm were recorded. An electronic caliper and magnifier were used to measure PWI. Patients were classified into normal or prolonged P-wave duration and dispersion. Stress test parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) at rest, peak, and recovery; target heart rate achieved; exercise duration; METs; and rate pressure products were recorded. Results: 76 patients were eligible with mean age of 43.77±12.16. 46% were male. 36% and 47% had prolonged P-wave duration and dispersion respectively. Patients with prolonged P-wave duration have higher peak DBP than those with normal duration (91.54±10.07 versus 84.69±9.60, P=0.006). Recovery SBP and DBP were also significantly higher. Among patients with prolonged P wave dispersion, recovery SBP and DBP were significantly higher compared with normal subjects (P<0.05). Conclusion: Prolonged PWI were associated with higher blood pressure response to exercise stress test. Further investigations may provide more conclusive evidences in the role of PWI as novel markers of future hypertension.