Peak Diastolic Blood Pressure Research Articles

RETRACTED ARTICLE: Discontinuation of medications classified as reuptake inhibitors affects treatment response of MDMA-assisted psychotherapy

RationaleMDMA-assisted psychotherapy is under investigation as a novel treatment for posttraumatic stress disorder (PTSD). The primary mechanism of action of MDMA involves the same reuptake transporters targeted by antidepressant medications commonly prescribed for PTSD.ObjectivesData were pooled from four phase 2 trials of MDMA-assisted psychotherapy. To explore the effect of tapering antidepressant medications, participants who had been randomized to receive active doses of MDMA (75–125 mg) were divided into two groups (taper group (n = 16) or non-taper group (n = 34)).MethodsBetween-group comparisons were made for PTSD and depression symptom severity at the baseline and the primary endpoint, and for peak vital signs across two MDMA sessions.ResultsDemographics, baseline PTSD, and depression severity were similar between the taper and non-taper groups. At the primary endpoint, the non-taper group (mean = 45.7, SD = 27.17) had a significantly (p = 0.009) lower CAPS-IV total scores compared to the taper group (mean = 70.3, SD = 33.60). More participants in the non-taper group (63.6%) no longer met PTSD criteria at the primary endpoint than those in the taper group (25.0%). The non-taper group (mean = 12.7, SD = 10.17) had lower depression symptom severity scores (p = 0.010) compared to the taper group (mean = 22.6, SD = 16.69). There were significant differences between groups in peak systolic blood pressure (p = 0.043) and diastolic blood pressure (p = 0.032).ConclusionsRecent exposure to antidepressant drugs that target reuptake transporters may reduce treatment response to MDMA-assisted psychotherapy.

Exercise pathophysiology differs between connective tissue diseases-associated pulmonary arterial hypertension and idiopathic pulmonary arterial hypertension.

Previous studies demonstrated that connective tissue diseases-associated pulmonary arterial hypertension (CTD-PAH) had a worse prognosis than idiopathic pulmonary arterial hypertension (IPAH), although the former one had better haemodynamic profiles and right heart function. To find potential explanations for this contradictory phenomenon, we compared the exercise pathophysiology of CTD-PAH with that of IPAH using cardiopulmonary exercise testing (CPET). Ninety-three CTD-PAH patients were retrospectively enrolled and matched 1:1 with 93 IPAH patients according to age, gender, body mass index, and body surface area. Multiple linear regression analysis was performed to adjust confounding factors. CTD-PAH had higher rest heart rate (HR@Rest) and lower rest oxygen uptake/HR (VO2/HR@Rest) than IPAH. During exercise, the peak power (Power@Peak), VO2@Peak, peak metabolic equivalents (METS@Peak), peak minute ventilation (VE@Peak), peak tidal volume (VT@Peak), HR@Peak, peak systolic blood pressure (SBP@Peak) and peak diastolic blood pressure (DBP@Peak) of CTD-PAH were lower than those of IPAH. After adjustment, CTD-PAH still had lower values of Power@Peak, VO2@Peak, METS@Peak, VT@Peak, VO2/HR@Rest, DBP@Peak and had higher HR@Rest than IPAH. CTD-PAH had more impaired ventilation, cardiac function and muscular strength (reflected by CPET-derived parameters) than IPAH, in despite of better haemodynamic profiles and comparable heart structure (assessed by echocardiography) and functional status (indicated by World Health Organisation functional class, N-terminal pro-brain natriuretic peptide and six-minute walk distance).

Abstract P063: Pressor Response To Acute Stress Is Regulated By Histamine In Humanized Sickle Cell Mice

Acute psychosocial stress has been linked to the onset of vaso-occlusive pain crises in patients with sickle cell disease (SCD), however mechanistic insight is lacking. Studies suggest that histamine is a stress-responsive factor and promotes inflammation. In SCD, histamine levels are elevated in association with vaso-occulsive crisis, however, the impact of acute stress is unknown. We hypothesized that acute stress in a humanized SCD mouse model stimulates the histamine pathway, inflammatory mediator release, and a pressor response. Acute stress was induced using cage switch stress (CSS) in male humanized SCD (HbSS) or control (HbAA) mice (n=6-8/group) with blood pressure (BP) monitored by radiotelemetry and mice terminated at baseline (BL, no CSS) and 30 min post-CSS for plasma measurements. Plasma histamine was unchanged in HbAA mice but was elevated in HbSS in response to CSS (nM; HbAA: 90.2±21.3; 104.3±10.2; HbSS: 91.1±13.6; 174.3±19.2*, *p<0.01 vs genotype BL). HbSS mice have significantly higher IL-6 levels at BL and post-CSS (ug/mL; HbAA: 20±4, 23±7; HbSS: 37±8, 65±5*, p genotype =0.0001, *p<0.05 vs genotype BL). Significant stress-by-genotype effects were found for E-selectin (ug/mL; BL vs CSS: HbAA: 7.9±0.9, 6.4±0.8; HbSS: 10±0.7, 13±1.4*, *p genotype <0.001) and P-selectin (ug/mL; BL vs CSS: HbAA: 29±2.7, 25±2.1; HbSS: 33±3.0, 42±4.1*, *p genotype <0.01). The peak mean arterial pressure response to CSS was blunted in HbSS versus HbAA mice and was driven by lower diastolic BP (DBP), not systolic BP. Mice were treated with H1 and H2 receptor antagonists, diphenhydramine and cimetidine, to examine the histamine pathway in the BP response to CSS. Following H1/H2 receptor antagonism, the CSS-induced peak DBP response was similar in HbAA mice, but was elevated in HbSS mice (change in BP, mmHg; vehicle vs H1/H2 blockade: HbAA: 32±2, 30±1; HbSS: 23±2, 31±2*, *p<0.05 vs genotype vehicle). These data reveal that acute stress stimulates histamine release and inflammatory mediators in HbSS mice but not HbAA. Further, the stress-induced DBP response is dependent on the histamine H1/H2 pathway in HbSS mice. These data identify that in SCD the histamine pathway may be stress-responsive and represents a link between acute stress and vaso-occlusive crises.

Differences in Post-Delivery Blood Pressures Between Women Who Will Develop Postpartum Preeclampsia and Controls [12M

INTRODUCTION: Postpartum preeclampsia (with first clinical manifestation after delivery) is poorly understood but has the potential for catastrophic consequences for patients. Predictive variables in the postpartum period may improve outcomes. The purpose of this study was to determine if there is a difference in blood pressure in the immediate postpartum period (delivery to discharge) in women readmitted with postpartum preeclampsia and controls. METHODS: Deliveries in a 5-year interval (2014-2019) at a university hospital were included in this retrospective cohort study (n=3,621 unique patients). IRB committee waiver was obtained for the study. Exclusion criteria were diagnosis of preeclampsia, eclampsia, or Hemolysis Elevated Liver Enzymes Low Platelets (HELLP) prior to delivery. Cases included readmissions for preeclampsia, eclampsia, or HELLP diagnosed after delivery (n=26). Controls were randomized from remaining patients (3:1 controls to cases, inflated by 10% to account for prevalence of exclusion criteria) (n=78). Each subject’s highest systolic (SBP) and diastolic blood pressure (DBP) from delivery until discharge was recorded. Two sample t-tests were used, significance set at 0.05. RESULTS: The mean peak SBP for cases was significantly higher than controls at 147.4 mmHg (SD 13.4 mmHg) compared to 133.3 mmHg (SD 12.0 mmHg) (P<.001). Mean peak DBP for cases was also higher than controls at 91.6 mmHg (SD 8.7 mmHg) compared to 82.9 mmHg (SD 8.0) (P<.001). CONCLUSION: Blood pressure in the immediate postpartum period was higher in women readmitted for postpartum preeclampsia compared to controls. This information may be a first step in developing a predictive model to better understand and predict postpartum preeclampsia.

Cardiopulmonary Exercise Testing Following Open Repair for a Proximal Thoracic Aortic Aneurysm or Dissection.

There are limited data on cardiopulmonary exercise testing (CPX) and cardiorespiratory fitness (CRF), following open repair for a proximal thoracic aortic aneurysm or dissection. The aim was to evaluate serious adverse events, abnormal CPX event rate, CRF (peak oxygen uptake, (Equation is included in full-text article.)O2peak), and blood pressure. Patients were retrospectively identified from cardiac rehabilitation participation or prospectively enrolled in a research study and grouped by phenotype: (1) bicuspid aortic valve/thoracic aortic aneurysm, (2) tricuspid aortic valve/thoracic aortic aneurysm, and (3) acute type A aortic dissection. Patients (n = 128) completed a CPX a median of 2.9 mo (interquartile range: 1.8, 3.5) following repair. No serious adverse events were reported, although 3 abnormal exercise tests (2% event rate) were observed. Eighty-one percent of CPX studies were considered peak effort (defined as respiratory exchange ratio of ≥1.05). Median measured (Equation is included in full-text article.)O2peak was <36% predicted normative values (19.2 mL·kgmin vs 29.3 mLkgmin, P < .0001); the most marked impairment in (Equation is included in full-text article.)O2peak was observed in the acute type A aortic dissection group (<40% normative values), which was significantly different from other groups (P < .05). Peak exercise systolic and diastolic blood pressures were 160 mm Hg (144, 172) and 70 mm Hg (62, 80), with no differences noted between groups. We observed no serious adverse events with an abnormal CPX event rate of only 2% 3 mo following repair for a proximal thoracic aortic aneurysm or dissection. (Equation is included in full-text article.)O2peak was reduced among all patient groups, especially the acute type A aortic dissection group, which may be clinically significant, given the well-established prognostic importance of reduced cardiorespiratory fitness.

Overlap syndrome: the coexistence of OSA further impairs cardiorespiratory fitness in COPD

Cardiorespiratory fitness (CRF) is an important prognostic marker in chronic obstructive pulmonary disease (COPD). Obstructive sleep apnea (OSA) also negatively affects exercise tolerance. However, the impact of their association on CRF has not been evaluated. We hypothesized that patients with overlap syndrome would demonstrate a greater impairment in CRF, particularly those with severe COPD. Individuals with COPD were recruited. First, subjects underwent clinical and spirometry evaluation. Next, home-based sleep evaluation was performed. Subjects with an apnea-hypopnea index (AHI) < 15 episodes/h were allocated to the COPD group and those with an AHI ≥ 15 episodes/h to the overlap group. On the second visit, subjects underwent a cardiopulmonary exercise test. Subsequently, they were divided into four groups according to the severity of COPD and coexistence of OSA: COPDI/II; overlap I/II; COPDIII/IV; and overlap III/IV. Of the 268 subjects screened, 31 were included. The overlap group exhibited higher values for peak carbon dioxide (COPD: 830 [678-1157]; overlap: 1127 [938-1305] mm Hg; p < 0.05), minute ventilation (COPD: 31 [27-45]; overlap: 48 [37-55] L; p < 0.05), and peak systolic blood pressure (COPD: 180 [169-191]; overlap: 220 [203-227] mm Hg; p <; 0.001) and peak diastolic blood pressure COPD: 100 [93-103]; overlap: 110 [96-106] mm Hg; p < 0.001). COPD severity associated with OSA produced a negative impact on exercise time (COPDIII/IV: 487 ± 102; overlap III/IV: 421 ± 94 s), peak oxygen uptake (COPDIII/IV: 12 ± 2; overlap III/IV: 9 ± 1 ml.Kg.min-1 ; p < 0.05) and circulatory power (COPDIII/IV: 2306 ± 439; overlap III/IV: 2162 ± 340 ml/kg/min.mmHg; p < 0.05). Overlap syndrome causes greater hemodynamic and ventilatory demand at the peak of dynamic exercise. In addition, OSA overlap in individuals with more severe COPD impairs CRF.

Retrospective clinical and morphological analysis of patients with AL amyloidosis (the 2008 to 2015 nephrobiopsies)

To study correlations between the clinical signs of dysfunction and pathological structural changes in the renal parenchyma in a group of Russian patients with AL amyloidosis in 2008-2015. A total group (At) including Group 1 with AL (kappa + lambda light chains) (n=46) was divided into subgroups: 2λ) 40 patients with AL-lambda (AL-λ); 3κ) 6 patients with AL-kappa (AL-κ). All the patients underwent standard laboratory and instrumental studies: determinations of the peak systolic and diastolic blood pressures (SBP and DBP, respectively, mm Hg), glomerular filtration rate (GFR) (ml/min/1.73 m2) by the EPI equation, daily protein loss (g/day). Polyclonal antibodies against kappa and lambda light chains, AA component, and transthyretin (DAKO, Denmark) were used as immunomorphological markers. Light optical structural changes were semiquantitatively assessed, by ranking the following analyzed sign: interstitial focal sclerosis (FS), tubular atrophy (TA), interstitial inflammatory infiltration (II) semi-quantitatively (0 - no; 1 - < 25%; 2 - <50%, 3 - >50% of the volume of a histological compartment). Glomerulosclerosis (GS) was defined as the percentage of sclerotic glomeruli. The extent of amyloid depositions in the renal parenchyma structures was estimated according to the procedure proposed by Ying Yao et al., 2013. The AL group showed a female preponderance (65.21%). The patients' mean age was 62±11 years. There were no significant differences in daily proteinuria and the levels of serum creatinine, GFR, SBP, and DBP between the groups. The predominant clinical manifestation in the patients was nephrotic syndrome. A comparative analysis of the pathomorphological criteria for the spread of amyloid masses and the markers of fibroplastic processes revealed no statistically significant differences in the studied groups. Correlation analysis of the spread of AL deposits in the renal parenchyma in the patients of Group 1 and Subgroup 2λ, as well as laboratory data showed that there were significant (p<0.05) correlations with GFR, serum creatinine, unlike in Subgroup 3κ. At the same time, the analysis demonstrated that daily proteinuria had a significant positive correlation with VA, IA, GA, and TA values in Subgroup 3κ, unlike in Group 1 and Subgroup 2λ. Positive correlations were found between glomerulosclerosis and VA in Subgroup 2 λ and IA in Group 1. Sclerotic (FS and TA) changes in the tubular interstitium (TIN) were significantly positively correlated with all the indicators of AL (GA, VA, IA, TA) in the examinees in Group 1 and Subgroup 2λ, but not in Subgroup 3κ. Inflammatory TIN infiltration showed statistically significant (p<0.05) positive correlations with IA and VA in Group 1 and Subgroup 2λ and their absence in subgroup 3κ. : The retrospective analysis of nephrobiopsy specimens from of patients with AL amyloidosis revealed that kidney damage was mainly associated with the development of λ-associated AL amyloidosis. The clinical and laboratory parameters were correlated with the pathomorphological criteria for loading the renal parenchyma with amyloid masses. The findings suggest that there are clinical and morphological features of the subclasses of AL amyloidosis, which may be of value for predicting the course and progression of the disease.

Prolonged Heightened Blood Pressure Following Mechanical Thrombectomy for Acute Stroke is Associated with Worse Outcomes.

Most data evaluating the relationship of post-mechanical thrombectomy (MT) blood pressure (BP) management and outcomes of patients with large vessel occlusion (LVO) focus on early BP control within the first 24h. We investigated the correlation of daily BP trends up to the third day following MT with patient outcomes. We retrospectively reviewed our prospectively maintained database for LVO patients treated with MT from February 2015 to December 2017. Recorded BP values for 72h post-reperfusion were reviewed. Daily peak systolic and diastolic blood pressures (SBP, DBP) were extracted for each day post-procedure. The association and importance between BP increments of 10mmHg and mortality, hemorrhage, and functional independence (FI = mRS ≤ 2) was analyzed in a multivariable logistic regression and random forest (RF) analyses modeling. A total of 212 thrombectomies were included. An increase in peak 24-h SBP was independently associated with higher likelihood of symptomatic hemorrhage (OR 1.2, p = 0.048) and decreased functional independence (OR 0.85, p = 0.03). Higher day 2 and day 3 peak SBP was strongly correlated with decreased functional independence and higher mortality. Third day SBP < 140 was independently associated with higher likelihood of functional independence (OR 4.3, p = 0.0004). Post-MT patients with and without functional independence demonstrated a similar relative decrease in peak SBP between the first 2days following thrombectomy (p = 0.26); however, those without functional independence experienced a significant rebound increase in peak SBP on the third day following MT (mean change from day 2 to 3: FI - 3.5mmHg, non-FI + 3.9mmHg; p = 0.005). High daily maximum SBP and a rebound SBP on the third day following MT is independently associated with increased likelihood of functional dependence.

Efficacy and safety of a first-in-class inhaled PDE3/4 inhibitor (ensifentrine) vs salbutamol in asthma

IntroductionThis study aimed to investigate the dose-response and pharmacology of a range of single doses of nebulised ensifentrine (RPL554), an inhaled dual phosphodiesterase (PDE) 3/4 inhibitor in patients with asthma. MethodsIn this randomised, placebo-controlled, double-blind crossover study, patients received single nebulised doses of ensifentrine 0.4, 1.5, 6 and 24 mg, salbutamol 2.5 and 7.5 mg, and placebo. Eligible patients were adults with asthma, pre-bronchodilator forced expiratory volume in 1 s (FEV1) 60–90% predicted and ≥1.5 L, with post-salbutamol FEV1 increase ≥15%. The co-primary objectives were peak and average FEV1 over 12 h for ensifentrine vs placebo and salbutamol. Secondary endpoints included: peak and average systolic and diastolic blood pressure, pulse rate and ECG heart rate; and safety and tolerability (adverse events [AEs], and serum potassium). ClinicalTrials.gov: NCT02427165. ResultsA total of 29 patients were randomised, with 25 (89%) completing the study. For the two co-primary endpoints there was a clear ensifentrine dose-response relationship, with all treatments superior to placebo (p < 0.001). There was no relationship between the ensifentrine dose and AE incidence or blood pressure. Ensifentrine 0.4, 1.5 and 6 mg had significantly lower effects than both salbutamol doses on pulse and heart rates. Ensifentrine did not impact potassium, whereas there was a was a dose-related reduction for salbutamol. Inhalation of ensifentrine resulted in a dose-related increase in plasma exposure. ConclusionsSingle-dose ensifentrine demonstrated dose-dependent bronchodilation, and was as effective as a therapeutic dose of nebulised salbutamol. All ensifentrine doses were similarly well tolerated, and did not show the characteristic β2-agonist systemic adverse effects.

Mechanical insufflation/exsufflation improves respiratory mechanics in critical care: Randomized crossover trial

This study evaluated the ventilatory and haemodynamic effects of the mechanical insufflator-exsufflator (MI-E) in critically ill patients. Sixteen mechanically ventilated patients performed three protocols: MI-E (-30/+30 cmH2O) plus endotracheal suctioning; 50S: MI-E (−50/+50 cmH2O) plus endotracheal suctioning; and isolated endotracheal suctioning (IES). The protocols were applied randomly in all subjects, with 3 -h intervals in between. Peak airway pressure (Ppeak), plateau pressure (Pplat), airway resistance (Raw), static compliance (Cst), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, peripheral oxygen saturation (SpO2) and amount of removed secretions were evaluated before (PRE), immediately after (POST) and 10 min after (10' POST) each protocol. The 50S protocol reduced Ppeak and Raw and increased Cst immediately after its application. Moreover, this protocol provided the largest amount of removed secretions and held SBP, DBP and SpO2 at basal values. The MI-E at high pressures promotes benefits to respiratory mechanics, is more effective in removing pulmonary secretions and it does not lead to hemodynamic repercussions.

Efeito de diferentes intervalos recuperativos sobre as respostas musculares, sanguíneas e hemodinâmicas

O treinamento com pesos é uma estratégia para controle de processos ocorridos com o envelhecimento e o período de intervalo entre as séries pode determinar a carga total de treinamento. O objetivo deste estudo foi analisar o desempenho muscular, lactato sanguíneo, índice de fadiga e variáveis hemodinâmicas em diferentes intervalos de recuperação após exercício isocinético. O estudo foi realizado com 11 indivíduos de meia idade (57.00 ± 7.2 anos) que praticavam treinamento com pesos a mais de seis meses. Os voluntários realizaram duas visitas ao Laboratório de Avaliação Física da Universidade, onde realizaram três séries de 10 repetições concêntricas com 60º/segundo na extensão e flexão de joelho em dinamômetro isocinético. Na primeira visita 60 segundos de descanso entre as séries foram realizados e na segunda visita 90 segundos. As variáveis analisadas foram pico de torque (Nm), Trabalho Total (J), Índice de Fadiga (%), Frequência Cardíaca (bpm), Pressão Arterial Sistólica e Diastólica (mmHg) e Concentração de Lactato Sanguíneo (mmol/L). Para comparação entre os dados foi utilizado a Análise de Variância (p&lt;0.05). Após análise pode-se verificar que não houve diferenças significativas entre intervalo de recuperação de 60 e 90 segundos na força muscular, índice de fadiga, concentração de lactato sanguíneo e variáveis hemodinâmicas. Conclui-se que para indivíduos que estão em processo de envelhecimento, aparentemente 60 ou 90 segundos de intervalo entre as séries ocasionam as mesmas respostas. Esse achado pode ser importante para profissionais da educação física na prescrição de exercícios.

Abstract 16662: Microvesicle Release During Exercise-Induced Cardiovascular Stress in Young Adult Hypertension

Introduction: Microvesicles are elevated in the circulation during cardiac stress; a response that is blunted in those with cardiovascular disease. Microvesicles play both activating and regulatory roles in the pathogenesis of hypertension, and their release is believed to be a protective mechanism during cardiac stress. Hypothesis: We hypothesised that microvesicle release during exercise-induced cardiac stress differs in young adults with and without hypertension. Methods: Microvesicle release was measured in 106 participants (79 normotensive, 27 hypertensive). Blood samples were obtained during maximal exercise testing at three time-points: before, immediately post and following 20 minutes recovery. The level of microvesicle procoagulant activity was determined in all participants. Microvesicles were phenotyped by flow cytometry in a subset of participants. Results: Exercise was associated with a significant elevation in the total procoagulant activity of microvesicles (p&lt;0.001) and this increase was significantly higher in the normotensive group than the hypertensives (median(IQR) +0.7(0.0-2.1) vs -0.1(-0.4-0.4), p=0.001). Circulating procoagulant, platelet, endothelial, leucocyte, granulocyte and monocyte-derived microvesicles were shown to be elevated during exercise (p&lt;0.05). The elevation in endothelial and leucocyte microvesicle levels returned to baseline within 20 minutes recovery. The significant elevation in procoagulant, platelet, granulocyte and monocyte-derived microvesicles was only seen in the normotensive participants, not in those with hypertension. Furthermore, amongst the normotensive participants, those with a blunted release of platelet microvesicles had higher peak diastolic blood pressures (86.8±8.4 vs 73.5±14.5, p=0.028) during exercise and increased global arterial stiffness measured at rest by the cardio-ankle vascular index (CAVI: 6.1±0.6 vs 5.4±0.5, p=0.022). Conclusions: In young adult hypertension there is a blunted release of microvesicles during exercise-induced cardiac stress. Normotensive young adults with a blunted platelet microvesicle release demonstrate early markers of future hypertension risk with greater peripheral resistance and arterial stiffness.

Significance of an Increase in Diastolic Blood Pressure During a Stress Test in Terms of Comorbidities and Long-Term Total and CV Mortality.

A decrease in diastolic blood pressure (DBP) with exercise is considered normal, but the significance of an increase in DBP has not been validated. Our aim was to determine the relationship of DBP increasing on a stress test regarding comorbidities and mortality. Our database was reviewed from 1993 to 2010 using the first stress test of a patient. Non-Minnesota residence, baseline cardiovascular (CV) disease, rest DBP <60 or >100 mm Hg, and age <30 or ≥80 were exclusion criteria. DBP response was classified: normal if peak DBP-rest DBP < 0, borderline 0-9, and abnormal ≥10 mm Hg. Mortality was determined from Mayo Clinic records and Minnesota Death Index. Logistic regression was used to determine the relationship of DBP response to the presence of comorbidities. Cox regression was used to determine total and CV mortality risk by DBP response. All analyses were adjusted for age, sex, and resting DBP. Twenty thousand seven hundred sixty patients were included (51 ± 11 years, female n = 7,314). Rest/peak averaged DBP 82 ± 8/69 ± 15 mm Hg in normal vs. 79 ± 9/82 ± 9 mm Hg in borderline vs. 76 ± 9/92 ± 11 mm Hg in abnormal DBP response. There were 1,582 deaths (8%) with 557 (3%) CV deaths over 12 ± 5 years of follow-up. In patients with borderline and abnormal DBP response, odds ratios for obesity, hypertension, diabetes, and current smoking were significant, while hazard ratios for total and CV death were not significant compared with patients with normal DBP response. DBP response to exercise is significantly associated with important comorbidities at the time of the stress test but does not add to the prognostic yield of stress test.

Resistance Training Improves Muscle Function and Cardiometabolic Risks But Not Quality of Life in Older People With Type 2 Diabetes Mellitus: A Randomized Controlled Trial

In older people with type 2 diabetes mellitus (T2DM), the effects of aging and T2DM may compromise the function of skeletal muscle, deteriorate metabolic status, and jeopardize physical performance, aerobic capacity, and quality of life (QoL). The purpose of this study was to investigate the effects of 12 weeks of resistance training (RT) on muscle function, physical performance, cardiometabolic risks, and QoL in older people with T2DM. This study was a randomized controlled trial that employed block randomization, assessor blinding, and the intention-to-treat principle. Thirty people 65 years or older with a diagnosis of T2DM were randomly assigned to either an exercise group or a control group and were further stratified by gender. The exercise group performed 8 RT exercises in 3 sets of 8 to 12 repetitions at 75% 1-repetition maximum (1-RM) 3 times per week for 12 weeks. The control group received usual care and maintained their daily activities and lifestyle. Muscle function (1-RM and muscle oxygenation responses), physical performance (5-repetition sit-to-stand test and Timed Up and Go test), cardiometabolic risks (aerobic capacity, blood pressure, body composition, glycemic control, lipids levels, and high-sensitivity C-reactive protein levels), and QoL (Audit of Diabetes-Dependent Quality of Life 19) were assessed at baseline (week 0) and after the 12-week interventions (week 12). The 1-RM chest-press and leg-press strength and physical performance in 5-repetition sit-to-stand test were significantly improved in the exercise group compared with the controls after the interventions. The exercise group had significantly lower resting systolic blood pressure (by -12.1 mm Hg, P = 0.036) than did the controls after 12 weeks of RT, without any significant within-group change in either group after intervention. The waist circumference, fasting glucose levels, and peak diastolic blood pressure tended to favor RT over usual care after the interventions. Twelve weeks of RT increased the maximal strength in chest-press and leg-press tests, and improved 5-repetition sit-to-stand performance in older people with T2DM. Our study demonstrated that supervised, structured RT was able to promote muscle function and alleviate cardiometabolic risks in people with T2DM 65 years or older.

Peak Blood Pressure Responses During Maximum Cardiopulmonary Exercise Testing

The objective of this study is to expand on previous efforts in establishing normative standards of exercising blood pressure (BP) at maximal physical exertion derived from treadmill cardiopulmonary exercise testing in the United States. Four experienced laboratories in the United States with established quality control procedures contributed data from September 1, 1986, to February 1, 2015. A total of 2917 maximal (peak respiratory exchange ratio ≥1.00) treadmill cardiopulmonary exercise testing responses from apparently healthy men and women (aged 20–79 years) without cardiovascular disease were submitted to FRIEND (Fitness Registry and the Importance of Exercise: A National Database). Percentiles of maximal systolic and diastolic BP were determined for each decade. Our results show a continued increase in peak systolic BP with age in both men and women to the sixth decade, followed by a plateau between the sixth and seventh decades. However, the trajectory of peak diastolic BP with age is different between men and women. Men showed an increase in peak systolic BP until the fifth decade, which plateaued by the seventh decade. In contrast, women showed a continued increase in peak diastolic BP across each decade. Existing reference data for exercising BP have not been updated for &gt;20 years. Normative peak exercising BP values from FRIEND can be used to provide a more current representation of maximal BP during exercise testing in the US population.

Acute blood glucose, cardiovascular and exaggerated responses to HIIT and moderate-intensity continuous training in men with type 2 diabetes mellitus.

Optimizing exercise-induced physiological responses without increasing the risk of negative exaggerated responses is an important aspect of exercise prescription for people with type 2 diabetes mellitus (T2DM). However, knowledge of acute responses, including exaggerated responses, of different training modalities is limited. The aim of the study was to compare acute physiological responses of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) in T2DM. Baseline data were used to randomly assign male participants into supervised training groups for a 12-week intervention. During week 7, participants trialed either a fully progressed MICT (N.=11) or HIIT (N.=11) (combined with resistance training) session. The MICT included 26 minutes at 55% estimated maximum workload (eWLmax) while the HIIT included twelve 1-minute bouts at 95% eWLmax interspersed with 1-minute bouts at 40% eWLmax. While energy expenditure and peak systolic and diastolic blood pressure responses were similar between groups (P=0.47, P=0.71, P=0.56, respectively), peak heart rate, workload and perceived exertion were higher in the HIIT group (P=0.04, P<0.001, and P<0.001, respectively). Acute exaggerated responses were similar (P=0.39) for MICT (64%) and HIIT (36%) participants. While structured MICT and HIIT sessions resulted in comparable acute physiological responses, the individual variations and exaggerated responses, even after preparatory training, necessitated precautionary respite in T2DM men.

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OBJECTIVES/SPECIFIC AIMS: Cocaine use is a significant health problem in the United States and associated with increased risk of adverse cardiovascular outcomes. Our goal was to evaluate the effects of rapid cocaine infusions on cardiovascular hemodynamics among patients with cocaine abuse disorder. METHODS/STUDY POPULATION: Patients with a history of cocaine abuse but no overt cardiovascular disease received 4 consecutive intravenous infusions of cocaine (0, 10, 20, 40 mg) given in randomized, double-blinded order. The infusion procedure was repeated on 2 consecutive days (4 infusions each day). Following each dose, patients underwent continuous monitoring via fingertip plethysmography for 30 minutes, followed by an additional 30 minutes washout procedure. Patients were surveyed throughout this timeline to record symptoms of cocaine response. Finger tracings were then used to calculate arterial pressure curves and parameters of heart rate, blood pressure, cardiac output, stroke volume, and systemic vascular resistance according to device-specific algorithms. Mean values were calculated over the entire 30 minutes follow-up and peak values were defined as the maximum value sustained over any 60-second interval during the follow-up period. RESULTS/ANTICIPATED RESULTS: Seven patients were enrolled and received cocaine infusions of 2 consecutive days. Cocaine dose was positively associated with mean cardiac output (R=0.489, p&lt;0.001), peak diastolic blood pressure (R=0.435, p=0.001), mean heart rate (R=0.401, p=0.003), peak systolic blood pressure (R=0.399, p=0.003), peak mean arterial pressure (R=0.362, p=0.008), mean systolic blood pressure (R=0.399, p=0.003), +dP/dt (R=0.346, p=0.012), and peak heart rate (R=0.334, p=0.015). Hemodynamic parameters were also predictive of patient-reported symptoms of cocaine response. DISCUSSION/SIGNIFICANCE OF IMPACT: These data confirm the known pharmacologic effect of cocaine to prevent reuptake of neurotransmitters and demonstrate the feasibility of conducting a noninvasive assessment of cardiovascular hemodynamics as a measure of responsiveness to cocaine infusions. This procedure also provides a benchmark to evaluate the potential impact of pharmacologic treatments on cocaine-induced hemodynamic changes and patient perceptions of cocaine response.

Abstract P364: Altered Circadian Rhythm in Blood Pressure in Obstructive Sleep Apnea

Background: In people with obstructive sleep apnea (OSA), adverse cardiovascular (CV) events occur most commonly during the night, about 6 hours earlier than the morning peak of events observed in the general population. In healthy individuals, circadian rhythms in many CV risk markers peak in the morning, around the common time of occurrence of adverse CV events. We therefore tested whether circadian rhythms are advanced in those with OSA, which might explain the earlier time of adverse CV events. Methods: Eleven volunteers (4 healthy controls and 7 OSA; 55 ± 5 years of age) completed a 5-day laboratory protocol with sleep and all other behaviors evenly spaced across the 24 h circadian period. To achieve this, after a baseline night, participants completed 10 consecutive short-day cycles of 2 h 40 min each of wakefulness and sleep opportunity. Blood pressure and heart rate were recorded 10 min after each wake time. Salivary melatonin and cortisol concentration were measured at 1-1.5h intervals during wakefulness. Cosinor analyses were performed to determine the rhythmicity of the all variables. We also compared OSA data with larger groups of historical healthy controls from our laboratory. Results: The circadian times of peak systolic and diastolic blood pressure were significantly advanced (up to 7 hours) in OSA as compared to healthy controls, p&lt;0.05. Circadian peaks in all other measured variables were not different between OSA and controls. Conclusions: These results suggest that OSA is associated with a change in the timing of endogenous circadian blood pressure rhythms. This may be specific to the cardiovascular system as there was no evidence for altered phase of melatonin or cortisol secretion patterns. The relatively advanced blood pressure rhythms in OSA is similar to the advancement of the time of adverse CV events in OSA and should be further investigated.

Exercise capacity and haemodynamic response among 12,327 individuals with cardio-metabolic risk factors undergoing treadmill exercise

Aims Haemodynamic parameters during and after exercise test seem to have a role in predicting cardiovascular events. We sought to evaluate the potential different responses in exercise capacity, heart rate and blood pressure levels in relation to major cardiovascular disease risk factors, among individuals undergoing exercise tolerance testing. Methods and results Consecutive individuals ( N = 12,327), aged 55 ± 11.8 years, underwent exercise tolerance testing, using the Bruce protocol. Obese participants showed higher values of peak systolic and diastolic blood pressure ( p < 0.01), with no heart rate differences. Diabetic patients presented increased systolic blood pressure across the test ( p = 0.02) and decreased tolerance to exercise ( p = 0.05), but without differences in diastolic blood pressure or heart rate. Hypertensives showed exaggerated blood pressure, chronotropic response and decreased capacity to exercise ( p < 0.001 for all). Smokers had increased baseline systolic blood pressure, peak diastolic blood pressure and recovery heart rate and decreased tolerance to exercise ( p < 0.001 for all). For all high-risk subgroups, exercise testing was more often positive. Age-stratified analysis revealed different patterns: all four risk factors significantly decreased peak metabolic equivalent in subjects <50 years old ( p < 0.05 for all), while in participants between 50 and 69 years old, diabetes mellitus ( p = 0.03), hypertension ( p = 0.04) and smoking ( p = 0.01) predicted achieved metabolic equivalent. For patients of ≥ 70 years old, obesity ( p = 0.006) and hypertension ( p = 0.02) decreased peak metabolic equivalent and systolic blood pressure recovery. In subjects without pre-existing cardiovascular disease and negative exercise tolerance testing (7064 subjects, mean age: 52.4 ± 12.1 years, 62.9% males), age, obesity, hypertension and female gender inversely and independently predicted peak metabolic equivalent. Conclusions High-risk individuals showed different haemodynamic responses when undergoing exercise tolerance testing, reflecting independent pathophysiological pathways.

Prediktori debljine intime i medije karotidnih arterija kod gojaznih adolescenata

Our aim was to assess cardiovascular risk factors that may predict increased carotid intima media thickness (cIMT) in obese children and adolescents. Children and adolescents were included in the cross-sectional study if they were aged 9-19 years and had primary obesity. Besides anthropometric and biochemical measurements, ambulatory blood pressure monitoring, measurement of carotid intima media thickness and exercise stress test were performed. We included 103 obese patients and divided them according to the ambulatory blood pressure findings in two groups: obese patients with and without ambulatory hypertension. There were 49 obese patients with and 54 without ambulatory hypertension Univariate analysis showed that there was a significant positive correlation of cIMT with age (r = 0.334, p = 0.001), body mass index (r = 0.288, p = 0.004), waist circumference (r = 0.352, p = 0.000), hip circumference (r = 0.288, p = 0.004), night-time systolic blood pressure (r = 0.226, p = 0.027), and peak diastolic blood pressure on exercise test (r = 0.241, p = 0.018). In a stepwise model, age, waist circumference and peak diastolic blood pressure on exercise test were independent predictors of cIMT.