Peak Systolic Blood Pressure Research Articles

Abstract 4124293: Exercise Capacity in Patients with Fontan Physiology

Introduction/Background: In the absence of a sub-pulmonary ventricle in the Fontan circulation, augmentation of pulmonary blood flow and filling of the systemic ventricle during exercise are limited. Cardiopulmonary exercise testing (CPET) is a reliable method for evaluation of aerobic capacity, gas exchange, and other physiologic parameters used for risk stratification in this population. Despite the ubiquitous use of CPET, reference ranges for patients with Fontan physiology are limited. The purpose of this study is to describe exercise characteristics and their relationship with different characteristics of Fontan physiology, imaging, and hemodynamics. Methods/Approach: In this retrospective cohort study, CPET results were reviewed for adult Fontan patients at the University of Washington between May 2021 and February 2024. Demographics, comorbidities, medications, type of Fontan conduit, imaging characteristics, hemodynamics, and exercise characteristics were included. Results were compared to a large previously published cohort of Fontan patients. Univariate linear regression was used to identify associations between demographics, cardiac anatomy, and exercise parameters. A p-value of less than 0.05 was considered statistically significant. Results/Data: Baseline demographics were notable for an older patient population (31±7 years) with lower indexed peak VO 2 (20.5±5.6 mL/kg/min) and greater V E /VCO 2 slope (37±7) compared to the historic cohort. Indexed peak VO2 was associated with age, BMI, type of Fontan conduit, FEV1, FVC, resting oxygen saturation, peak systolic blood pressure, and peak heart rate. Indexed peak VO 2 was notably not significantly associated with sex, systemic ventricular morphology, ventricular systolic function, Fontan pressure, or the presence of conventional heart failure medical therapy. Conclusions: In the growing population of older patients with Fontan physiology, development of age-specific population normative data may increase the clinical utility of CPET. Further investigation of the relationship between imaging characteristics, hemodynamics, and exercise parameters is needed in the Fontan population.

Abstract 4146301: Relationship Between Calf Muscle Pump Function and Exercise Stress Testing

Background: Exercise stress testing uses metabolic equivalents of tasks (METs) to measure the energy cost of activities, aiding in the assessment of exercise capacity and cardiovascular health. Despite its significance, the correlation between calf muscle pump function (CPF) and exercise stress testing remains unexplored. We aimed to evaluate the relationship between CPF and peak METs as determined by cardiopulmonary treadmill exercise stress testing. Methods: The study included adults who underwent exercise cardiopulmonary stress testing and venous plethysmography at Mayo Clinic between April 2017 and March 2020. The protocols other than Bruce, Mayo, Modified Naughton, and Naughton protocols were excluded. The CPF ejection fraction (EF) was calculated per leg based on refill volumes post-exercise as a percentage of passive drain refill. The classification of CEAP (Clinical-Etiology-Anatomy-Pathophysiology) was utilized to better understand chronic venous insufficiency (CVI). Results: A total of 155 patients who underwent both exercise stress testing and venous plethysmography were included, with a mean age of 61.31 ± 14.03 years, and 84 (54.2%) were male. The peak measured METs for normal, unilaterally reduced, and bilaterally reduced CPF were 8.5 (2.5), 7.3 (2.1), and 7.1 (2.4), respectively (p=0.004, Figure 1). Multiple linear regression models were developed with METs as the outcome to determine if CPF was an independent predictor of METs on cardiopulmonary exercise stress testing. IIn model 1, the following independent variables were included: resting heart rate, peak heart rate, peak systolic blood pressure, recovery heart rate at minute 1, and worst EF (Table 1). In model 1, with only exercise parameters, lower EF was associated with lower METs (p=0.03). In a second analysis, variables identified as statistically significant with METs in the initial model were included, along with CEAP class (model 2) and CCI (model 3) (Table 2). In model 2, CEAP class 3 or higher was associated with decreased METs on the exercise stress test. This correlation implies that individuals with moderate to severe CVI may influence exercise capacity, demonstrating the interconnectedness of the cardiovascular system. Moreover, in model 3, the CCI, a predictor for mortality, was not significantly associated with METs. Conclusion: Our findings revealed that more severe CVI (CEAP class and reduced CPF) was associated with reduced exercise capacity after accounting for other factors.

Comparative insights into type non-A non-B vs type B acute aortic syndromes and their blood pressure management: a monocentric, retrospective, 11-year study

Abstract Background Acute aortic syndromes (AAS) are classified either as type A, if the ascending aorta is involved, or as type B, if only the descending aorta is; AAS affecting the aortic arch, alone or in combination with the descending aorta, have recently been classified as type non-A-non-B (NANB). Few and discordant data are available about the differences between type B and type NANB AAS, especially in terms of presentation, management and prognosis. Little evidence also exists about the effects of blood pressure (BP) management, peaks and variability on in-hospital outcomes in such context. In particular, the largest international AAS registry suggests a comparable course and prognosis, while a recent meta-analysis indicates a poorer clinical outcome with higher rate of complications, need of invasive treatment and mortality in the case of type NANB AAS. Methods We conducted a monocentric, observational, analytical, retrospective registry study including all patients ≥ 18 years old admitted to our tertiary referral hospital with a diagnosis of type B or type NANB AAS from January 2011 to December 2021. Epidemiological, clinical, operative and outcome data were analyzed by comparing type B and type NANB AAS patients. We also focused on systolic and diastolic BP, in terms of both peak values as well as BP variability (BPV); BPV was defined as the difference between the peak and the through value on a certain day. Blood pressure variables were analyzed in relationship with mortality and the failure of an initial conservative management. Results 274 type B and 44 type NANB AAS patients were enrolled. The only significant differences between the two groups were a higher rate of pre-operative complications in type NANB patients (p=0.002) resulting in a higher rate of invasive management (p=0.005), particularly as failure of an initial conservative strategy (p=0.018). However, comparable rates of post-operative complications and in-hospital mortality (overall 7%) were observed. In the overall population, lower limb ischemia, ST segment depression, and post-operative visceral ischemia were associated with higher in-hospital mortality. Peri-aortic effusion was independently associated with failure of conservative management, whereas diagnosis of intramural hematoma (as opposed to other subtypes of AAS) appeared to be protective. Among all BP variables (including anti-hypertensive treatment intensity and daily systolic or diastolic BP peaks and variability), only peak systolic BP on day 5 was found to be non-independently associated with a higher risk of in-hospital mortality and failure of an initially conservative strategy. Conclusions In our study type NANB AAS were more often complicated and treated invasively than type B AAS, while having the same rates of post-operative complications and overall mortality. BP peaks had only a minor effect on outcomes, while BPV and BP management intensity did not have any significant impact.OutcomesBlood Pressure

Test-retest reliability of exercise blood pressure and the workload-indexed systolic blood pressure slope in healthy males and females.

The reliability of blood pressure (BP) measured during submaximal and maximal exercise, and confounding effects of biological sex, remain to be fully established but have implications for using exercise BP as a cardiovascular risk factor. We hypothesize that exercise BP test-retest reliability will not differ between sexes but will be higher during submaximal compared to maximal exercise. Eighty-four participants (22±5 years; 36 females) completed two maximal treadmill tests (modified Bruce protocol) separated by ≥2 days. Exercise BP was measured every 90-seconds using automated auscultation (Tango M2 monitor). Breath-by-breath oxygen uptake was analyzed. Test-retest reliability was assessed using two-way, mixed effects, consistency, single-rater intraclass correlation coefficient (ICC) analysis on the total group and separated by sex at submaximal and maximal exercise. Systolic BP during submaximal (ICC=0.65 [0.49-0.76], p<0.01) and maximal (ICC=0.66 [0.52-0.77], p<0.01) exercise both displayed substantial reliability between visits. In contrast, the SBP/MET slope showed poor submaximal (ICC=0.12 [-0.09-0.33], p=0.13) but substantial maximal (ICC=0.63 [0.48-0.75], p<0.01) exercise reliability. Females showed substantial reliability in submaximal systolic BP (ICC=0.73 [0.53-0.85], p<0.01), and peak systolic BP (ICC=0.74 [0.54-0.87], p<0.01) and SBP/MET slope (ICC=0.78 [0.60-0.88], p<0.01); the submaximal SBP/MET slope had fair reliability (ICC=0.28 [-0.06-0.56], p=0.05). Males showed moderate reliability in submaximal systolic BP (ICC=0.53 [0.26-0.72], p<0.01), and peak systolic BP (ICC=0.41 [0.15-0.62], p<0.01) and SBP/MET slope (ICC=0.48 [0.22-0.67], p<0.01); the submaximal SBP/MET slope had poor reliability (ICC=0.06 [-0.18-0.31], p=0.32). Systolic BP showed similar reliability during submaximal and maximal exercise, with females demonstrating higher reliability in exercise systolic BP compared to males.

O95 HYPERTENSIVE RESPONSE TO EXERCISE RELATIVE-TO-FITNESS AND LEFT VENTRICULAR HYPERTROPHY ARE ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR EVENTS: EVIDENCE FROM THE EXERCISE STRESS TEST COLLABORATION (EXERTION) STUDY

Background. A hypertensive response to exercise (HRE) is associated with a high prevalence of left ventricular hypertrophy (LVH), both being related to an increased risk of cardiovascular disease (CVD). However, these associations may be influenced by aerobic capacity (fitness). This study aimed to determine if an HRE considered relative-to-fitness and LVH are associated with increased risk for CVD events. Methods. Records for 4,307 individuals (aged 58.6±12.7 years, 52.0% male) who underwent exercise stress echocardiography were linked to administrative health datasets (hospital and emergency admissions) to ascertain CVD events (n=458, mean follow-up, 44.8±25.9 months). LVH presence/absence (LVH+/LVH-) was defined as LV mass index adjusted for body surface area around a cut point of ≥115 g/m2 for men and ≥95 g/m2 for women. HRE presence/absence (HRE+/HRE-) relative-to-fitness was defined as peak systolic blood pressure (SBP) divided by peak metabolic equivalents around a cut point of ≥90th percentile. Survival analysis using Cox-proportional hazard regression was used to compare CVD event rates across the four groups defined by the combinations of HRE+/HRE- with LVH+/LVH-, adjusted for age, sex, pre-exercise SBP, and CVD history. Results. Compared to the reference group (HRE-/LVH-), there was a stepwise increase in CVD event rate (Figure 1) across the following groups: HRE+/LVH- [Adjusted HR(95%CI), 1.34(1.02-1.76)], HRE-/LVH+ [Adjusted HR(95%CI), 2.1(1.6-3.76)], HRE+/LVH+ [Adjusted HR(95%CI), 2.55(1.64-3.97)]. Conclusion. Individuals with both HRE considered relative-to-fitness and LVH are at the highest risk of CVD events, greater than either clinical presentation alone. These results emphasise the need to address an HRE and low fitness in people with LVH to improve CVD risk management.

Cardiopulmonary Response to Acute Exercise before Hemodialysis: A Pilot Study.

Disparities in physical fitness between immediately before dialysis (pre-D) and the day following dialysis (non-D) have not been investigated despite potential adverse factors such as fluid status, uremia, and electrolyte levels in the pre-dialysis period. The effect of acute exercise immediately before hemodialysis (HD) on HD-related hypotension remains unclear. We hypothesized that cardiopulmonary performance and muscular strength would be inferior in the immediate pre-D period compared to those non-D. Twenty patients receiving chronic HD treatments underwent symptom-limited incremental cardiopulmonary exercise testing (CPET) and isokinetic testing both 1-2 h prior to dialysis (pre-D) and non-D. This investigation was a sub-study of a clinical trial assessing the efficacy of a pre-D exercise training program. Blood pressure profiles during HD post-CPET and pre-D exercise training were compared with those during usual HD sessions. No adverse events were observed during the 80 exercise tests. Prior to dialysis, the nadir of the ventilatory equivalent of CO2 was slightly elevated, the resting heart rate was lower, and the peak systolic blood pressure was higher than those non-D. Contrary to our hypothesis, peak <inline-formula><mml:math id="m1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mover accent="true"><mml:mi mathvariant="normal">V</mml:mi><mml:mo>˙</mml:mo></mml:mover><mml:msub><mml:mi mathvariant="normal">O</mml:mi><mml:mn>2</mml:mn></mml:msub></mml:mrow></mml:math></inline-formula> and quadriceps peak torque showed no differences. Blood pressure profiles during HD post-exercise were similar to those during sessions without prior exercise, except for a lower resting systolic blood pressure at the beginning of HD. Cardiopulmonary response and muscular strength in the 1-2 h prior to HD were comparable with those on the day following HD, with only minor clinically insignificant differences. Acute exercise prior to HD did not affect the magnitude of hypotension during HD. This study suggests a potential alternative timing for exercise training or testing in patients undergoing chronic HD.

Higher blood glucose is associated with the severity of hemorrhagic transformation after endovascular therapy for stroke

ObjectivesHyperglycemia is associated with poor outcome in large vessel occlusion (LVO) stroke, with mechanism for this effect unknown. Materials and methodsWe used our prospective, multicenter, observational study, Blood Pressure After Endovascular Stroke Therapy (BEST), of anterior circulation LVO stroke undergoing endovascular therapy (EVT) from 11/2017-7/2018 to determine association between increasing blood glucose (BG) and intracerebral hemorrhage (ICH). Our primary outcome was degree of ICH, classified as none, asymptomatic ICH, or symptomatic ICH (≥4-point increase in National Institutes of Health Stroke Scale [NIHSS] at 24 h with any hemorrhage on imaging). Secondary outcomes included 24 h NIHSS, early neurologic recovery (ENR, NIHSS 0-1 or NIHSS reduction by ≥8 within 24 h), and 90-day modified Rankin Scale (mRS) using univariate and multivariable regression. ResultsOf 485 enrolled patients, increasing BG was associated with increasing severity of ICH (adjusted OR, aOR 1.06, 95 % CI 1.02-1.1, p < 0.001), higher 24 h NIHSS (aOR 1.22, 95 % CI 1.11-1.34, p < 0.001), ENR (aOR 0.90, 95 % CI 0.82-1.00, p < 0.002), and 90-day mRS (aOR 1.06, 95 % CI 1.03-1.09, p < 0.001) when adjusted for age, presenting NIHSS, ASPECTS, 24-hour peak systolic blood pressure, time from last known well, and successful recanalization. ConclusionsIn the BEST study, increasing BG was associated with greater odds of increasing ICH severity. Further study is warranted to determine whether treatment of will decrease ICH severity following EVT.

Exercise systolic blood pressures are unaffected by time of day in healthy young adults.

Blood pressure (BP) assessment during exercise testing has the capacity to identify exaggerated exercise BP (EEBP). BP has a circadian rhythm; therefore, exercise BPs may change throughout the day complicating EEBP identification. The purpose of this study was to determine the effect of time of day on exercise BP in healthy young adults. Thirty-one participants [48% female; 23(4) years] completed a modified Bruce treadmill protocol in the morning (M), afternoon (A), and evening (E). Submaximal (stage 4) and peak (highest value) systolic BP (SBP) were determined and ΔSBP was calculated (peak SBP-pre-exercise SBP). Repeated-measures tests were used to compare SBP data. EEBP was defined as a submaximal SBP ≥ 170 mmHg. Chronotype was assessed using the Morning-Eveningness Questionnaire (MEQ) and Pearson correlations were used to determine the relationship between MEQ score and ΔSBP during all tests. Significance was set at P < 0.05. Submaximal SBP (M:159(25); A:156(16); E:162(24) mmHg; P = 0.295), peak SBP (M:177(32); A:184(25); E:185(26) mmHg; P = 0.087) and ΔSBP (M:62(29); A:67(23); 65(20) mmHg; P = 0.546) were similar across time points. Eight participants had an EEBP on at least two tests. MEQ scores were correlated with ΔSBP during the A test (r = 0.357, P = 0.049) and E test (r = 0.363, P = 0.045). In conclusion, time of day had no effect on SBP responses to exercise, but our correlational analysis suggests changes in SBP may differ between chronotypes depending on the time of day of exercise. Given the clinical value of EEBP, it is notable that 26% of our healthy young sample had EEBP.

Determinants of prolonged baseline blood pressure restoration following autonomic dysreflexia for individuals with spinal cord injuries

Objective This study aimed to identify the determinants affecting the time required for blood pressure (BP) restoration after autonomic dysreflexia (AD) and to propose a new method for BP measurement in individuals with cervical spinal cord injury (SCI) who experience AD. Methods In a prospective, single-center observational study, participants’ bladders were filled with body-temperature saline until reaching cystometric capacity, as confirmed by previous urodynamic studies. Restoration time (RT), defined as the time from the onset of voiding until BP returned to baseline, was measured during the morning voiding session. This session involved the use of a 10F hydrophilic transurethral catheter. Data were then compared with various clinical determinants including demographic, urodynamic, and cystographic variables. Results The study included 29 individuals with cervical SCI. Notable variations in RT were observed among individuals with differing levels of detrusor overactivity (DO) and bladder compliance. An inverse correlation was noted between RT and bladder compliance, whereas positive correlations were identified with maximal detrusor pressure, peak systolic BP (SBP), and the magnitude of BP changes. Factors associated with prolonged RT included injury completeness, bladder trabeculation, vesicoureteral reflux (VUR), DO, and changes in SBP. Conclusions A significant association was found between BP elevation and prolonged RT. Determinants such as the severity of the SCI, bladder trabeculation, VUR, and DO were correlated with prolonged RT, considering their importance in the assessment of baseline BP following AD.

Cardiopulmonary Exercise Testing in Evaluating Transthyretin Amyloidosis.

Cardiopulmonary exercise testing (CPET) has an established role in the assessment of patients with heart failure. However, data are lacking in patients with transthyretin (ATTR) amyloidosis. To use CPET to characterize the spectrum of functional phenotypes in patients with ATTR amyloidosis and assess their association with the cardiac amyloid burden as well as the association between CPET parameters and prognosis. This single-center study evaluated patients diagnosed with ATTR amyloidosis from May 2019 to September 2022 who underwent CPET at the National Amyloidosis Centre. Of 1045 patients approached, 506 were included and completed the study. Patients were excluded if they had an absolute contraindication to CPET or declined participation. The mean (SD) follow-up period was 22.4 (11.6) months. Comparison of CPET parameters across disease phenotypes (ATTR with cardiomyopathy [ATTR-CM], polyneuropathy, or both [ATTR-mixed]), differences in CPET parameters based on degree of amyloid infiltration (as measured by cardiovascular magnetic resonance [CMR] with extracellular volume mapping), and association between CPET parameters and prognosis. Among the 506 patients with ATTR amyloidosis included in this study, the mean (SD) age was 73.5 (10.2) years, and 457 participants (90.3%) were male. Impairment in functional capacity was highly prevalent. Functional impairment in ATTR-CM and ATTR-mixed phenotypes (peak mean [SD] oxygen consumption [VO2], 14.5 [4.3] mL/kg/min and 15.7 [6.2] mL/kg/min, respectively) was observed alongside impairment in the oxygen pulse, with ventilatory efficiency highest in ATTR-CM (mean [SD] ventilatory efficiency/volume of carbon dioxide expired slope, 38.1 [8.6]). Chronotropic incompetence and exercise oscillatory ventilation (EOV) were highly prevalent across all phenotypes, with both the prevalence and severity being higher than in heart failure from different etiologies. Worsening of amyloid burden on CMR was associated with decline in multiple CPET parameters, although chronotropic response and EOV remained abnormal irrespective of amyloid burden. On multivariable Cox regression analysis, peak VO2 and peak systolic blood pressure (SBP) were independently associated with prognosis (peak VO2: hazard ratio, 0.89 [95% CI, 0.81-0.99; P = .03]; peak SBP: hazard ratio, 0.98 [95% CI, 0.97-0.99; P < .001]). In this study, ATTR amyloidosis was characterized by distinct patterns of functional impairment between all disease phenotypes. A high prevalence of chronotropic incompetence, EOV, and ventilatory inefficiency were characteristic of this population. CPET parameters were associated with amyloid burden by CMR and with peak VO2, and SBP, which have been shown to be independent predictors of mortality. These findings suggest that CPET may be useful in characterizing distinct patterns of functional impairment across the spectrum of amyloid infiltration and predicting outcomes, and potentially offers a more comprehensive method of evaluating functional capacity for future prospective studies.

Is cardiac rehabilitation after pci as effective as cabg? The first experience from the eastern mediterranean region cardiac rehabilitation registry.

The effectiveness of cardiac rehabilitation (CR) programs following either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) has been separately studied. Few studies have compared the effects of similar CR programs between PCI and CABG. This study aimed to compare the effects of CR in patients recruited following either PCI or CABG on coronary heart disease risk factors, psychological variables, and functional capacity. For this retrospective study, the documents of the CR program registry of the Isfahan Cardiovascular Research Institute were reviewed from 2008 to 2021. Patients with ischemic heart disease undergoing PCI or CABG were enrolled in an 8-week exercise-based cardiac rehabilitation program. Demographics, smoking status, clinical data, echocardiographic parameters, laboratory data, functional capacity, and psychological status were assessed. Patients who underwent CABG (n=557) were more likely to be referred to CR than those who underwent PCI (n=440). All variables changed significantly after the CR program compared to their baseline value in both the PCI and CABG groups. However, low-density lipoprotein and total cholesterol levels, peak systolic blood pressure, and resting and peak diastolic blood pressure did not change in any of the groups, and fasting blood sugar (p=0.01) and triglyceride (TG) (p=0.01) levels significantly decreased only in the PCI group. Between-group comparisons indicated that after adjustment, no significant difference was observed between the PCI and CABG groups except for TG, which was significantly reduced in the PCI group (p=0.01). The CR program was equally effective in patients who underwent either PCI or CABG.

Exploration of cardiac rehabilitation nursing for elderly patients with myocardial infarction based on individualized cardiac rehabilitation.

Myocardial infarction is a high-risk condition prevalent among the elderly population, often leading to adverse clinical manifestations such as reduced cardiopulmonary function, anxiety, and depression post-surgery. Consequently, cardiac rehabilitation holds immense importance in mitigating these complications. To evaluate the effect of individualized cardiac rehabilitation on blood pressure variability (BPV) and baroreflex sensitivity (BRS) in elderly patients with myocardial infarction. A cohort of 74 elderly patients diagnosed with myocardial infarction and admitted to our hospital between January 2021 and January 2022 were subjected to random selection. Subsequently, all patients were divided into two groups, namely the research group (n = 37) and the control group (n = 37), utilizing the number table method. The control group received conventional drug treatment and nursing guidance intervention, while the study group underwent individualized cardiac rehabilitation in addition to the interventions received by the control group. All patients were continuously intervened for 12 wk, and the BPV of these two groups in the 1st wk (T0), the 4th wk (T1) and the 12th wk (T2) were compared, BRS, changes in cardiopulmonary function measures, and adverse cardiovascular events. Of 24 h diastolic BPV, 24 h systolic BPV, carbon dioxide ventilation equivalent slope of the research group were lower than those of the control group at T1 and T2, BRS, peak heart rate and systolic blood pressure product, 1 min heart rate recovery were higher than those of the control group, and the incidence of adverse events in the research group was lower than that of the control group, the difference was statistically significant (P < 0.05). In this study, we found that after individualized cardiac rehabilitation in elderly patients with myocardial infarction, BPV and BRS can be effectively improved, cardiac function is significantly enhanced, and a better prognosis is obtained.

Exercise systolic blood pressure response during cycle ergometry is associated with future hypertension in normotensive individuals.

We aimed to investigate the association between the exercise systolic blood pressure (SBP) response and future hypertension (HTN) in normotensive individuals referred for cycle ergometry, with special regard to reference exercise SBP values and exercise capacity. In this longitudinal cohort study, data from 14 428 exercise tests were cross-linked with Swedish national registries on diagnoses and medications. We excluded individuals with a baseline diagnosis of cardiovascular disease or HTN. The peak exercise SBP (SBPpeak) was recorded and compared with the upper limit of normal (ULN) derived from SBPpeak reference equations incorporating age, sex, resting SBP, and exercise capacity. To evaluate the impact of exercise capacity, three SBP to work rate slopes (SBP/W-slopes) were calculated, relative to either supine or seated SBP at rest or to the first exercise SBP. Adjusted hazard ratios [HRadjusted (95% confidence interval, CI)] for incident HTN during follow-up, in relation to SBP response metrics, were calculated. We included 3895 normotensive individuals (49 ± 14 years, 45% females) with maximal cycle ergometer tests. During follow-up (median 7.5 years), 22% developed HTN. Higher SBPpeak and SBPpeak > ULN were associated with incident HTN [HRadjusted 1.19 (1.14-1.23) per 10 mmHg, and 1.95 (1.54-2.47), respectively]. All three SBP/W-slopes were positively associated with incident HTN, particularly the SBP/W-slope calculated as supine-to-peak SBP [HRadjusted 1.25 (1.19-1.31) per 1 mmHg/10 W]. Both SBPpeak > ULN based on reference values and high SBP/W-slopes were associated with incident HTN in normotensive individuals and should be considered in the evaluation of the cycle ergometry SBP response.

Multivariable risk model for postpartum re-presentation with hypertension: development phase

ObjectivesPostpartum hypertension is one of the leading causes of re-presentation to hospital postpartum and is associated with adverse long-term cardiovascular risk. Postpartum blood pressure monitoring and management interventions have been...

Effects of mindful physical activity on perceived exercise exertion and other physiological and psychological responses: results from a within-subjects, counter-balanced study.

Most adults are insufficiently active. Mindfulness training may increase moderate to vigorous physical activity (MVPA) adoption and adherence. However, physiological and psychological factors underlying these effects are not well understood. This study examined the effects of an acute bout of MVPA, mindfulness training, and combined MVPA and mindfulness training on physiological and psychological outcomes. Healthy adults (N = 29, Mage = 28.6) completed 20-min counterbalanced conditions: (a) mindfulness training (MIND); (b) moderate intensity walking (PA), and (c) moderate intensity walking while listening to MVPA-specific guided mindfulness training (PAMIND). Heart rate (HR), Rating of Perceived Exertion (RPE), Feeling Scale (FS) and Blood Pressure (BP) were measured at rest, at regular intervals during each condition, and post-condition. Mindfulness, state anxiety, and self-efficacy were assessed pre- and post-condition. Average and peak HR, systolic BP (SBP), and RPE were significantly higher, and average and peak FS were significantly lower during the PA and PAMIND conditions compared to MIND (p < 0.001). Average RPE was significantly higher for PA compared to PAMIND (p < 0.001). Heart rate, feeling scale, body and mental events mindfulness, and self-efficacy for walking increased from pre to post (all p's < 0.001) for all conditions. Time by condition interactions were significant for change in heart rate, mental events mindfulness, and state anxiety from pre- to post-condition. The physiological response to MVPA and PAMIND were similar. However, RPE was rated lower in the PAMIND condition, which could have implications for MVPA adoption and maintenance. Future work should further explore RPE combining MVPA and mindfulness training.

Physiological and haemodynamic differences between peak exercise blood pressure and blood pressure-power output slope in healthy women

Abstract Background A hypertensive response to exercise (HRE) is considered indicative of increased arterial stiffness (1). However, HRE is common in individuals with high cardiorespiratory fitness (CRF) (2), which we hypothesize is due to increased stroke volume (SV) and cardiac output (Qc). Purpose This study compared differences in CRF and peak-exercise SV (SVpeak) and Qc (Qcpeak) according to absolute and workload-indexed definitions of exercise hypertension in women. Methods Women free of overt CVD (n=142; 52±8years, BMI: 26.3±4.5kg/m2) underwent exercise cardiac magnetic resonance to quantify SVpeak and Qcpeak, and cardiopulmonary exercise testing to quantify peak VO2, power output (PO) and systolic blood pressure (SBP) responses. SBP-PO slope was determined using linear regression of SBP and PO values obtained every 2-minutes throughout exercise. HRE was defined as peak SBP ≥190mmHg (3), and elevated SBP-PO slope was defined as a slope &amp;gt;90th percentile for sex and age based on previously published values (4). Results 51% and 23% of the cohort met criteria for HRE and elevated SBP-PO slope, respectively, with 16% meeting both criteria. HRE was associated with higher VO2peak (2.03±0.53 vs 1.83±0.44 L/min, P=0.015), peak PO (191±66 vs 167±51 Watts, P=0.014), SVpeak (109±27 vs 98±19 mLs, P=0.008), and Qcpeak (15.1±3.3 vs 13.9±2.8 L/min, P=0.023). In contrast, elevated SBP-PO slope was associated with lower VO2peak (1.57±0.36 vs 2.04±0.48 L/min), peak PO (135±34 vs 192±60Watts) SVpeak (88±13 vs 108±24 mLs) and Qcpeak (12.5±1.8 vs 15.1±3.1 L/min; P&amp;lt;0.001 for all). Overall, the group with HRE and elevated SBP-PO slope had the lowest physical capacity, VO2peak and haemodynamic response to exercise (Figure 1A-D), whilst the opposite trend was seen for those with a HRE and a normal SBP-PO slope. All results remained significant (P&amp;lt;0.05) after adjustment for age, BMI, resting SBP and menopausal status (pre vs peri/post-menopausal). Conclusion Contextualising exercise SBP responses against measures of PO better accounts for confounding from increased Qcpeak, and may improve identification of women with increased arterial stiffness.Figure 1A-D

Abnormal workload-indexed blood pressure response to exercise in patients at risk of or with overt heart failure

Abstract Background Conflicting evidence exists regarding the functional and prognostic significance of hypertensive response to exercise (HRE), commonly defined as peak systolic blood pressure (SBP) &amp;gt;210 mmHg in males and &amp;gt;190 mmHg in females. No study yet has explored the impact of sex-specific, workload-indexed HRE in patients at different stages of the heart failure (HF) spectrum, as defined by the American College of Cardiology/American Heart Association HF staging system. Purpose We evaluated the SBP/Workload slope during exercise across the HF spectrum and investigated the hemodynamic, functional and prognostic correlates of HRE. Methods Fifty-eight healthy controls, 201 subjects at risk of developing HF (HF Stages A-B), and 369 patients with a definite diagnosis of HF (Stage C) were enrolled; among the latter, 143 had preserved (HFpEF) and 226 reduced (HFrEF) left ventricular ejection fraction. All patients underwent a combined cardiopulmonary-exercise stress echocardiography test. For each patient, we recorded at least two BP measurements during exercise: the first within the first minute of exercise and the last at peak effort. The SBP/Workload slope was calculated as the difference in SBP over the corresponding increment in watts (W): (SBPpeak – SBPfirst)/(Wpeak – Wfirst). In each ACC/AHA HF Stage, we divided patients according to SBP/Workload slope tertiles; HRE was defined as the highest sex-specific SBP/Workload slope tertile. A composite of all-cause mortality and hospitalization for cardiovascular reasons was chosen as the primary outcome. Results The median SBP/Workload slope was 0.53 (interquartile range 0.36-0.72) mmHg/W and was steeper in women than in men in all subgroups (p&amp;lt;0.0001). After adjusting for age and sex, SBP/Workload slope was significantly higher in Stages A-B (0.61, 0.47-0.75 mmHg/W) and HFpEF (0.63, 0.42-0.86 mmHg/W) compared to controls (0.43, 0.35-0.57 mmHg/W) and HFrEF (0.47, 0.30-0.63 mmHg/W, Figure 1). In all subgroups, patients with HRE showed significantly lower peak oxygen consumption and peripheral oxygen extraction (Table). After a median follow-up of 16 months, HRE was an independent predictor of adverse outcomes (Hazard Ratio 2.05, 95% confidence interval 1.81-5.18), while rest and peak absolute SBP values did not. Kaplan-Meier analysis confirmed a worse survival probability for patients with HRE in Stages A-B and HFpEF but not in HFrEF. After adjusting for confounding factors, the patients with the highest SBP/Workload slope had a 47% higher risk of the primary outcome than subjects in the lowest tertile (Figure 2). Conclusions Across the HF spectrum, patients with HRE, as evaluated by the SBP/Workload slope, present with peculiar pathophysiological features and impaired functional capacity. This is especially true for those in Stages A-B and patients with HFpEF. In these subgroups, HRE may portend an increased risk of adverse cardiovascular outcomes.SBP/workload slopesKaplan-Meier curves and Hazard Ratios

The effect of 12 weeks supervised exercise-based cardiac rehabilitation on resting and exercise blood pressure in males and females

Abstract Background Exercise is key in the prevention and management of hypertension. It remains unclear to what extent sex differences exist with regard to changes in blood pressure (BP) in patients following an exercise-based cardiac rehabilitation (CR) program. Purpose To investigate the effect of a 12 week supervised exercise-based CR program on resting BP (BPrest), peak exercise BP (BPmax) and systolic BP (SBP)/metabolic equivalents (MET)-slope and compare sex differences. Methods Of 2963 patients referred for CR at a singular test centre in Belgium during the years 2010-2019, those with missing BP data or with a submaximal (RER&amp;lt;1.1) cardiopulmonary exercise test (CPET) were excluded. Reasons for referral included post myocardial infarction, percutaneous coronary intervention, coronary artery bypass surgery and valve surgery. Patients underwent a bicycle CPET with BP measured at rest seated on the bike (BPrest) and throughout the test using an automated auscultatory BP machine at baseline and after 12 weeks of CR. BPrest, BPmax, peak oxygen uptake (VO2peak), peak workload (Wattpeak), resting heart rate (HRrest), maximal HR (HRmax) and the SBP/MET-slope were recorded from each test. CR incorporated 3 sessions of supervised aerobic and resistance exercise per week. Results A final sample of 2500 patients (20.4% females) were included for analysis with similar age (62±11 for males vs 61±11years for females, P=0.142). More males were on an ACE-inhibitor (55 vs 46% females, P&amp;lt;0.001) with a comparable prevalence of beta-blocker usage between sexes (75 vs 71% females, P=0.053). At both baseline and 12 weeks, females had a significantly lower body mass index, VO2peak, Wattpeak, BPmax and HRmax compared to males (P&amp;lt;0.001 for all) but a higher HRrest (P&amp;lt;0.001). However, both sexes had similar BPrest and SBP/MET-slope at baseline and 12 weeks. After 12 weeks of CR both males and females had a comparable mean±SD improvement in VO2peak (+4.1±3.2 and +3.1±2.6mL/kg/min), and Wattpeak (+33±22 and +22±15Watts), respectively (P&amp;lt;0.001 for all). This was associated with an increased SBPmax for males (171±30 to 181±30mmHg, P&amp;lt;0.001) and for females (159±29 to 167±30mmHg, P&amp;lt;0.001) from baseline to 12 weeks respectively. No change was seen in SBPrest between baseline and 12 weeks for males (128±20 to 128±19mmHg, P=0.39) and females (129±21 to 128±19mmHg, P=0.21) respectively. The SBP/MET-slope also remained unchanged after 12 weeks CR for males (8.97±5.48 to 9.04±4.81mmHg/MET, P=0.63) and for females (8.68±7.11 to 9.19±6.16mmHg/MET, P=0.13) respectively. Conclusion Twelve weeks of exercise-based CR was associated with an increase in SBPmax, although this was largely proportional to the improvement in exercise capacity demonstrated by the unchanged SBP/MET-slope and this was similar in both sexes. These routine clinical markers require further interrogation as to whether they parallel improvements in vascular health associated with exercise training.

Abstract 15558: Blood Pressure Responses During Exercise Were Associated With Average Home Blood Pressure and Home Blood Pressure Variability: The Electronic Framingham Heart Study

Introduction: Abnormal blood pressure (BP) responses during exercise are associated with incident hypertension and cardiovascular disease, but how exercise BP responses relate to average home BP and home BP variability (BPV) over one-year follow-up is unknown. Objective: We investigated whether exercise BP was associated with average home BP and home BPV, after accounting for resting BP, in the electronic Framingham Heart Study (eFHS). We hypothesized that higher exercise BP predicts higher average home BP and home BPV over one-year follow-up. Methods: At a FHS research exam (2016-2019), participants underwent maximum incremental ramp cycle ergometry cardiopulmonary exercise testing (CPET) with BP measured every two minutes. Participants enrolled in the eFHS were provided with a digital BP cuff to measure home BP weekly for up to one year. Linear regression models were used to examine associations of exercise BP with average home systolic BP (SBP) and week-to-week average real variability (ARV) of home SBP over one-year follow-up, adjusting for covariates. ARV, which considers both the dispersion and order of BP readings, was quantified as the average of the absolute differences between consecutive BP readings. We used p&lt;0.05 for significance. Results: The study sample included 806 participants (mean age 53 years, 58% women, 46% hypertension, median number of home BP returns 22, average home SBP 122 mmHg). Adjusting for resting SBP and other covariates, higher exercise SBP (as measured by peak SBP, SBP at 75 Watts, and SBP/workload slope) was associated with higher average home SBP ( Figure 1A ). Higher SBP/workload slope was associated with elevated ARV of home SBP in men ( Figure 1B ). Conclusion: Higher exercise SBP responses are associated with higher average digital home-based SBP and home-based SBP variability over one-year follow-up after accounting for resting SBP.

Abstract 15399: Cardiac Sympathetic Nerve Activity in Women With a History of Takotsubo Syndrome: A Novel Stress Myocardial Radionuclide Imaging Strategy

Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) systolic dysfunction, triggered by physical or emotional stress, and associated with increased long-term cardiovascular morbidity. Cardiac iodine-123-meta-iodobenzylguanidine (mIBG) imaging has previously demonstrated sympathetic hyperactivity in the TTS subacute state which improves at follow-up during rest imaging. Cardiac neuronal dysfunction in response to stress has not been evaluated in recovered TTS. Hypothesis: Sympathetic hyperactivity, as measured by stress mIBG, is abnormal in TTS after recovery of LV ejection fraction (LVEF). Methods: To elicit a sympathetic challenge, women with history of TTS with recovered LVEF (n=19) and asymptomatic age- and sex-matched reference controls (n=10) underwent treadmill (6 minutes) with simultaneous mental-stress testing (public speaking with anger recall). mIBG (10 mCi) was injected during exercise, and planar and SPECT imaging were performed at 15 min (early) and 240 min (late), followed by Tc-99m tetrofosmin myocardial perfusion imaging. Early and late heart-to-mediastinal ratio (HMR) and washout rate (WR) corrected for background were calculated. Results: Median time from last TTS event was 23 months (range 4-56). Overall mean age was 60± 12 years, body mass index 25 ± 4kg/m 2 , resting LVEF 70 ± 7%, 41% hypertension and 0% diabetes with no difference between TTS and controls. TTS had higher resting (140 ± 22 vs 123 ± 19 mmHg, p=0.049) and peak (187 ± 17 vs 171 ± 15 mmHg, p= 0.018) systolic blood pressure. While the early HMR and WR were similar, the late HMR was significantly lower in the TTS group (Figure). Conclusions: Women with a history of TTS have lower late HMR but similar WR, suggesting neuronal dysfunction in response to sympathetic challenge persists long after recovery from TTS event. Further analysis of catecholamine levels and central nervous system neural pathways will explore the mechanism of dysregulation.