Systolic Blood Pressure Response Research Articles

Hypotensive Response on Cardiopulmonary Stress Test is Associated with Increased One Year Mortality After Continuous Flow Left Ventricular Assist Device Implantation

Purpose Cardiopulmonary stress testing (CPX) is widely used to evaluate patients with end stage heart failure who may benefit from advanced therapies, such as durable left ventricular assist devices (LVAD). A hypotensive systolic blood pressure response on CPX may identify a subpopulation with the highest risk physiology. We sought to evaluate long term outcomes among LVAD recipients with a pre-implantation hypotensive response. Methods This was a retrospective single center study using consecutive patients implanted with a continuous flow LVAD between 1/2011 and 1/2019 at our Institution. Patients with CPX performed within 12 months before implantation were included. Hypotensive response was defined as a peak exercise systolic blood pressure lower than the resting systolic blood pressure. The primary outcome was 1-year mortality. Multivariable cox regression analysis was performed to evaluate the relationship between hypotensive exercise blood pressure response and mortality. Multivariate linear regression analysis was used to determine pre-implant variables and mortality. Results 313 patients were enrolled in the study and 123 were identified to meet our inclusion criteria. The mean age was 60.1 years, 58% had ischemic cardiomyopathy and 85% were classified as INTERMACS 3-5. 54 patients had a hypotensive response on CPX (44%). A total of 14 patients died at 1 year, 10 from the hypotensive cohort (p=0.043), hazard ratio 3.54 with 95% CI (1.1, 11.3, p=0.033). Post-implantation ICU and overall hospital length of stay were similar to the group with normal blood pressure response. There was also no significant difference in post-operative complications and the risk of re-hospitalization at 1 month, 6 months and 1 year. Conclusion Hypotensive blood pressure response on the CPX performed pre-LVAD implantation is independently associated with increased 1-year mortality. Additional studies are needed to further characterize this high-risk patient population and to identify strategies to improve survival rates.

Associations Between Financial Strain and Emotional Well-Being With Physiological Responses to Acute Mental Stress.

This study aimed to investigate associations between financial strain and emotional well-being, health, and physiological responses to acute mental stress. Participants were 542 healthy men and women aged 53 to 76 years from the Whitehall II study divided into those who reported no (n = 316), some (n = 135), or moderate/severe (n = 91) financial strain. Emotional well-being and self-reported health were assessed at baseline and 3 years later. Laboratory mental stress testing involved assessment of blood pressure (BP), heart rate, and lipid reactivity and recovery, and plasma interleukin 6 responses to challenging behavioral tasks. Analyses adjusted for objective financial status, age, sex, socioeconomic status (SES), and marital status. Financial strain was positively associated with more depressive symptoms; lower positive affect; greater loneliness; lower optimism, self-esteem, and sense of control; and poorer self-reported physical health, mental health, and sleep (all, p < .001). Longitudinally, financial strain predicted poorer outcomes 3 years later, but associations were attenuated after baseline levels were taken into account. Financial strain was associated with reduced systolic and diastolic BP reactivity to acute stress (mean systolic BP increase = 32.34 [15.2], 28.95 [13.1], and 27.26 [15.2] mm Hg in the none, some, and moderate/severe financial strain groups), but not with heart rate, interleukin 6, or lipid responses. Financial strain was correlated with a range of emotional and health-related outcomes independently of objective financial status. The diminished BP reactions to acute mental stress suggest that financial strain may contribute to dynamic chronic allostatic load.

Characterization of the blood pressure response during cycle ergometer cardiopulmonary exercise testing in black and white men : Data from the Fitness Registry and Importance of Exercise: A National Database (FRIEND).

It has been established that blacks have higher overall incidence and prevalence of hypertension compared to their white counterparts. However, the maximum blood pressure (BP) response of blacks to exercise has not been characterized. A total of 5996 apparently healthy men from the Fitness Registry and Importance of Exercise: A National Database (FRIEND) who underwent maximum cardiopulmonary exercise tests on a cycle ergometer were included in this analysis. Of these participants, 1245 (21%) self-identified as black while the remaining 4751 (79%) identified as white. All subjects had a respiratory exchange ratio (RER) of ≥1.0 and had no reports of cardiovascular or pulmonary disease. Systolic BP (BP) response to exercise was indexed according to increase in workload (SBP/MET-slope). Both racial groups were subdivided into age groups by decade. Black men had higher peak SBP and higher SBP/MET-slopes compared to white men across all age groups (p < 0.001). Resting SBP was not different between blacks and whites except within the 18-29-year age group. The differences in peak SBP and SBP/MET-slope between age and race groups indicate that black men have an exaggerated BP response to exercise irrespective of resting BP values. Further investigation is warranted to determine the underlying mechanisms responsible and clinical implications for this exaggerated BP response to exercise.

Eight weeks of device-guided slow breathing decreases sympathetic nervous reactivity to stress in posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is characterized by increased risk for developing hypertension and cardiovascular disease. We recently showed that device-guided slow breathing (DGB) acutely lowers blood pressure (BP) and muscle sympathetic activity (MSNA) and improves baroreflex sensitivity (BRS) in PTSD. The aim of this study was to assess the long-term benefits of DGB on autonomic function at rest and during stress. We hypothesized that long-term DGB improves arterial BRS and lowers BP and MSNA in PTSD. Twenty-five veterans with PTSD were studied and randomized to either 8 wk of daily DGB (n = 12) or 8 wk of sham device (Sham; n = 13). BP, heart rate (HR), and MSNA were measured at rest and during mental math. Arterial BRS was assessed using the modified Oxford technique. Resting MSNA, BP, and heart rate (HR) remained comparable before and after 8 wk in both groups (DGB and Sham). Likewise, the change in sympathetic and cardiovagal BRS was not different between the groups. Interestingly, DGB significantly decreased MSNA reactivity to mental math when expressed as burst frequency (P = 0.012) or burst incidence (P = 0.008) compared with Sham, suggesting a sustained effect of DGB on sympathetic reactivity to stress in PTSD. Contrary to our hypothesis, long-term DGB did not lower systolic BP, diastolic BP, or HR responses to stress compared with Sham. Likewise, pulse pressure reactivity after 8 wk (P = 0.121) was also comparable. In summary, these data suggest that long-term use of DGB may lead to a sustained dampening of sympathetic reactivity to mental stress in PTSD.

Arterial Stiffness Predicts General Anesthesia–Induced Vasopressor-Resistant Hypotension in Patients Taking Angiotensin-Converting Enzyme Inhibitors

Patients chronically treated with angiotensin-converting enzyme inhibitors (ACEIs) may develop hypotension after induction of general anesthesia. A fraction of these patients are resistant to therapeutic doses of vasopressors, which poses serious concerns for hemodynamic management. The authors hypothesized that the patients who develop refractory hypotension, compared with those who do not, show lower central arterial stiffness due to the profound effect of ACEIs. Prospective observational study. Single tertiary center. Fifty surgical patients chronically treated with ACEIs were enrolled. Prior to surgery, all the patients had central arterial stiffness assessment measured by carotid-femoral pulse-wave velocity. Patients were categorized into 2 groups according to the systolic blood pressure response during the first 10 minutes after induction of general anesthesia: a vasopressor-resistant hypotension group requiring more than 200 µg phenylephrine, or a control group requiring no more than 200 µg of phenylephrine to maintain systolic blood pressure above 90 mmHg during the study period. Carotid-femoral pulse-wave velocity was significantly lower in the vasopressor-resistant hypotension group compared to the control group (7.6 [7.2-8.3] m/s v 9.9 [8.7-12.0] m/s, p = 0.001 [Hodges-Lehman median difference 2.2, 95% confidence interval = 1.1-4.4]). These findings suggested that preoperative measurement of carotid-femoral pulse-wave velocity in patients chronically treated with ACEIs could help identify patients at increased risk of developing hypotension refractory to vasopressors after induction of general anesthesia.

Hemodynamic Response to Isometric Handgrip Exercise in Adults with Intellectual Disability.

Individuals with intellectual disability (ID) have an increased risk of cardiovascular disease and reduced work capacity, which could partly be explained by alterations to autonomic and hemodynamic regulation. The measurement of heart rate and blood pressure during isometric handgrip (HG) exercise, a sympathoexcitatory stimulus, is a noninvasive method to investigate autonomic and hemodynamic alterations. The purpose of this study was to assess alterations to autonomic and associated hemodynamic regulation between individuals with ID and a matched control group during isometric HG exercise. Individuals with ID (n = 13; 31 ± 2 yr, 27.6 ± 7.7 kg·m-2) and without ID (n = 16; 29 ± 7 yr, 24.2 ± 2.8 kg·m-2) performed 2 min of isometric HG exercise at 30% of maximal voluntary contraction (MVC) in the seated position. Blood pressure was averaged for 2 min before, during, and after HG exercise (mean arterial pressure [MAP], systolic blood pressure, and diastolic blood pressure). Heart rate variability, blood pressure variability, and baroreflex sensitivity were calculated from the continuous blood pressure and heart rate recordings. Isometric HG elicited a blunted response in systolic blood pressure, diastolic blood pressure, and MAP among individuals with ID compared with individuals without ID, even after controlling for strength (MAP: rest, HG, recovery; ID: 103 ± 7, 108 ± 9, 103 ± 7; without ID: 102 ± 7, 116 ± 10, 104 ± 10 mm Hg; interaction P < 0.05). Individuals with ID also had an attenuated baroreflex sensitivity response to HG exercise compared with individuals without ID (interaction P = 0.041), but these effects were no longer significant after controlling for maximal voluntary contraction. Indices of heart rate variability and blood pressure variability were not different between groups overall or in response to HG exercise (P > 0.05). Individuals with ID have a blunted hemodynamic and autonomic response to isometric HG exercise compared with individuals without ID.

Test-retest reliability of the Valsalva maneuver in spinal cord injury

Objective: To determine the test-retest reliability of quantitative and qualitative baroreflex sensitivity (BRS) parameters derived from the Valsalva maneuver (VM) in individuals with traumatic cervical SCI. Design: Test-retest reliability. Setting: Tertiary rehabilitation center. Participants: Fourteen participants with cervical SCI (ranging from C3-C8 neurological level). Outcome Measurements: Beat-to-beat systolic blood pressure (SBP) traces (finger photoplethysmography) were obtained during a 15-second forced expiration at two time points (7.6 ± 2.9 days between sessions) to assess VM reliability. Test-retest reliability of BRS metrics from derived from the VM (Valsalva ratio; VR, pressure recovery time; PRT, vagal baroreflex sensitivity; BRSv, adrenergic baroreflex sensitivity; BRSa1, and total recovery; TR) were assessed by intra-class correlation coefficient (ICC, with 95% confidence interval; CI) and by qualitative reproducibility (V, N, or M pattern). Results: ICCs for quantitative parameters were (CI): VR = 0.894 (0.703–0.965), TR = 0.927 (0.789–0.976), BRSa1 = 0.561 (0.149–0.911), PRT = 0.728 (0.343–0.904), BRSv = 0.243 (−0.309–0.673). Qualitatively, 12 subjects (85.7%) demonstrated reproducible VM patterns at both time points (3 “M” pattern, 8 “V” pattern and one “N” pattern). Conclusion: VR (a measure of cardiovagal function) and TR (a measure of sympathetic adrenergic function) are reliable quantitative parameters that can be derived from SBP response to VM in participants with SCI. Qualitative waveform analysis was reproducible in 12/14 participants. This provides the foundational evidence required to pursue further validity testing to establish a role for VM in the assessment of autonomic functions in SCI.

Cadmium exposure activates NADPH oxidase, renin–angiotensin system and cyclooxygenase 2 pathways in arteries, inducing hypertension and vascular damage

Exposure to high concentrations of cadmium (Cd), widely used in many industries and found in air, food and contaminated water, is not uncommon. Cd damages the cardiovascular system, but the vascular mechanisms involved are not fully understood. This study investigated the mechanisms involved in cardiovascular damage after exposure to high Cd concentrations. Three-month-old male Wistar rats were treated intraperitoneally for 14 days with distilled water (Untreated group) or 1 mg/kg cadmium chloride (Cd group). We investigated the systolic blood pressure (SBP) and vascular reactivity of mesenteric resistance arteries (MRA) and the aorta by analysing contractile and relaxation responses in the absence and presence of the endothelium; we also evaluated pathways involved in vascular tone regulation. Superoxide anion production, COX-2 protein expression and in situ detection of COX-2, AT-1, and NOX-1 were evaluated. Oxidative status, creatinine level and angiotensin-converting enzyme (ACE) activity in plasma were also evaluated. Fourteen-day exposure to a high Cd concentration induced hypertension associated with vascular dysfunction in MRA and the aorta. In both vessels, there was increased participation of cyclooxygenase 2 (COX2), angiotensin II type 1 (AT1) receptor and NOX1. MRA also presented endothelial dysfunction, denoted by impaired acetylcholine-mediated relaxation. All vascular changes were accompanied by increased reactive oxygen species production and COX2, NOX1 and AT1 receptor expression in vascular tissue. Overall, high Cd concentrations induced cardiovascular damage: hypertension, endothelial dysfunction and vascular damage in conductance and resistance arteries, NADPH oxidase, renin–angiotensin system and COX2 pathway activation.

Acute Effects Of Firefighting On Vascular Health And Blood Pressure

Firefighting is strenuous and dangerous work. Sudden cardiac death accounts for approximately 50% of firefighter line of duty deaths. PURPOSE: To determine the vascular and hemodynamic responses firefighting work across different positional assignments. METHODS: 40 experienced male firefighters completed a coordinated fire attack in a wood frame residential structure. Responding personnel were classified based upon four separate positions (assignments), including: Outside Command, Outside Vent, Inside fire suppression and search and rescue, Overhaul. Subjects were equipped with an automated blood pressure and pulse wave analysis device for measurement of cardiovascular variables (Mean Arterial Pressure, Total Vascular Resistance, Cardiac Output, Stroke Volume, Pulse-Wave Velocity). Measurements were made before, immediately after, and 30 minutes after fire suppression activities in a single-story residential structure. RESULTS: Increased mean arterial pressure (MAP) measured prior to the exercise indicates an anticipatory rise in sympathetic activation across all positions (Table 1). Those performing Inside suppression/search and rescue exhibited the greatest increase in MAP across all groups, with MAP remaining elevated immediately following the training exercise and a return to baseline conditions occurring 30 minutes post training (Table 1). This group also exhibited the greatest excursion in systolic blood pressure in response to training (Pre: 130.7 ± 12.7, Post: 134.6 ± 17.3). CONCLUSIONS: The vascular changes evidenced during acute firefighting may play a mechanistic role in the increased risk of sudden cardiac death with firefighting. Additional research is needed to better understand how these changes are related to myocardial blood flow.Table 1: Data are expressed as Average (SD)

Comparing Isometric Exercise Protocols Using A Novel Exercise Ball Versus A Traditional Computerized Dynamometer

Hypertension is the leading risk factor for death and disability worldwide. Isometric handgrip (IHG) training is endorsed as one of the “Best Proven Nonpharmacological Interventions for Prevention and Treatment of Hypertension” by the American Heart Association/American College of Cardiology in their current guidelines. Barriers such as cost of the handgrip devices and tedium arising from repeating the same exercises, pose a challenge for widespread implementation of IHG training. Therefore, alternative devices that provide potential for a wide variety of isometric exercises warrant further investigation. PURPOSE: To determine whether an acute bout of IHG exercise, performed with a novel exercise ball (NEB), elicits similar cardiovascular responses and ratings of perceived exertion (RPE) to a traditional IHG device (TID). METHODS: Ten healthy adults (age: 24±7 yrs; ♀= 7; systolic blood pressure (BP)/diastolic BP: 99/56±9/6 mmHg) randomly performed two different IHG exercise protocols, one with the NEB, and the other with the TID. Both protocols involved 4, 2-min isometric contractions with 1-min rest periods between contractions, but NEB employed hand and adductor isometric contractions at 20-30% of maximum voluntary contraction (MVC), while the TID protocol involved alternating handgrip contractions performed at 30% of MVC. Heart rate (HR) and BP were recorded pre-, mid-, and post-exercise bout, as well as every 5-min during seated rest. RPE was assessed using the Borg CR-10 scale, following each contraction. The two protocol bouts were separated by 30-min of seated rest. RESULTS: The NEB and TID protocols elicited similar HR and systolic BP responses (p>0.05). However, the TID protocol elicited a greater diastolic BP response (12±1 mmHg) than the NEB protocol (8±1 mmHg; p=0.026). Additionally, a higher RPE was observed for TID, compared to NEB (p<0.001). CONCLUSION: This preliminary data suggests that the NEB protocol elicits similar cardiovascular responses (HR and systolic BP) while being perceived to require less effort, compared to the TID. Such an isometric exercise ball offers the potential for a wide variety of isometric exercises to be performed during training. Supported by University of Windsor Research Stimulus Fund Grant 813306

Relationship Between The Blood Pressure Responses To Acute And Chronic Aerobic Exercise Among Adults With Hypertension

Aerobic exercise acutely reduces blood pressure (BP) 5-7 mmHg among adults with hypertension, termed postexercise hypotension (PEH). PEH has been shown to be highly correlated to the BP response to exercise training in the laboratory. However, this relationship has yet to be explored under ambulatory conditions and compared to a control sham session (CONTROL) which is necessary to account for the circadian variation in ambulatory BP (ABP). PURPOSE: To examine the relationship between PEH (ABPACUTE) and the systolic BP (ASBP) and diastolic ambulatory BP (ADBP) responses to aerobic exercise training (ABPCHRONIC). METHODS: Adults with hypertension (n=24) completed a graded-exercise stress test (GEST) and CONTROL before and after 12wk moderate intensity aerobic exercise training. Ambulatory BP was assessed immediately after each experiment until the next morning and averaged at hourly intervals over 19hr. ABPACUTE was the difference between pre-training GEST minus CONTROL ABP. ABPCHRONIC was post- minus pre-training CONTROL ABP. ANCOVA tested differences in ABP over time with resting BP as a covariate. Multiple variable regression examined relationships among ABPACUTE and ABPCHRONIC. RESULTS: Subjects were middle-aged (52.3±10.8y), physically inactive adults with hypertension (136.3±10.7 / 85.2±8.9mmHg). Following the GEST, ABPACUTE (ASBP/ADBP) were lower -5.9±5.7mmHg /-2.9±4.1mmHg than CONTROL (ps<0.006). Following 12wk of aerobic exercise training, post-training ABP CONTROL (137.9±11.0 / 81.7±6.5mmHg) was not different than pre-training ABP CONTROL (137.5±6.6 / 80.5±5.7; ps>0.404). Multivariable regression analysis revealed that resting SBP, body mass index (BMI), and ASBPACUTE explained ~40% of the variance in ASBPCHRONIC, with ASBPACUTE explaining ~17% of the variance in ASBPCHRONIC (p=0.03). Similarly, resting DBP, BMI, and ADBPACUTE explained ~40% of the variance in ADBPCHRONIC, while DBPACUTE explained ~11% of the variance to DBPCHRONIC (p=0.06). CONCLUSION: ABPACUTE explained ~11-17% of the variability in exercise training-induced changes in ABPCHRONIC. The magnitude of the correlations we observed between ABPACUTE and ABPCHRONIC under ambulatory conditions appear to be less than those reported previously in the laboratory and merit further investigation.

L-citrulline Supplementation Attenuates Aortic Pressure And Wave Reflection Responses To Cold Stress In Older Adults

PURPOSE: Aging is a major risk factor for cardiovascular events due to increased pressure wave reflection. Cold exposure augments central blood pressure and wave reflection due to sympathetic-mediated vasoconstriction, which elevates the risk for adverse cardiovascular events in older adults. L-citrulline (L-CIT) supplementation improves endogenous synthesis of nitric oxide and contributes to reduce aortic systolic blood pressure (SBP) and pulse pressure (PP) responses to cold pressor test (CPT) in young men; however, the impact on wave reflection in older adults is unknown. The purpose of this study was to elucidate the efficacy of L-CIT to attenuate aortic hemodynamic responses to CPT in older adults. METHODS: Sixteen adults (n=16, 60-85 yrs) were randomly assigned to placebo or L-CIT (6g/day) for 14 days in a crossover, double-blind design. Brachial and aortic SBP, PP, augmented pressure (AP), augmentation index standardized at 75 bpm ([email protected]), and pressure of the forward (Pf) and reflected (Pb) waves were evaluated at rest and during CPT before and after the assigned intervention. An analysis of variance with repeated measures was used to determine if there were differences within and between interventions at rest and during CPT. RESULTS: No significant changes with either intervention were observed at rest. Responses in aortic PP (-9.1 vs. 2.9; P=.008), AP (-4.1 vs. 2.1; P=.004), AIx (-3.7 vs. 2.1; P = .015), [email protected] (-3.4 vs. 2.4; P = .024), Pf (-5.1 vs. 2.9; P = .034), and Pb (-3.4 vs. 1.7; P = .027) were significantly attenuated following L-CIT supplementation compared with placebo. CONCLUSIONS: Although L-CIT had no effect on resting aortic hemodynamics, L-CIT attenuated aortic pressure and wave reflection responses during CPT in older adults. Therefore, short-term L-CIT supplementation may elicit cardioprotection during cold exposure in older adults.

Hemodynamic Performance In Patients With A Bicuspid Aortic Valve During Treadmill Ramp Exercise Testing

PURPOSE: To evaluate the effect of a bicuspid aortic valve on the hemodynamic response to a treadmill ramp protocol in pediatric patients. METHODS: We evaluated 18 patients with a bicuspid aortic valve (BAV) and 18 normal subjects (C), age and size matched, using a Ramp Treadmill protocol. Neither group was treated with a Beta Blocker. Resting aortic valve peak gradient (PG) and shortening fraction (SF) were evaluated by echocardiography for the BAV group. Systolic blood pressure (SBP), cardiac output and stroke volume (SV) were obtained at rest and maximal exercise. Maximal oxygen pulse (MO2P), percent predicted oxygen pulse (%PO2P) and respiratory exchange ratio (RER) were obtained at maximal exercise. RESULTS: There were no significant differences between the BAV and C groups in age (14.6 ± 2.1 vs 15.8 ± 3.1(yr)), height (1.63 ± 0.1 vs 1.66 ± 0.12(m)) or weight (55.7 ± 15.1 vs 57.6 ± 13.2 (kg)). The BAV group had a resting PG of 16.5 ± 8 mmHg and a SF of 39.5 ± 4.9 %. The SBP in the BAV group was significantly decreased at rest (113 ± 9 vs 120 ± 10 mmHg) p<0.05) and exercise (160 ± 14 vs 174 ± 19 (mmHg) p<0.02) compared to the C group. BAV group had a significantly decreased SV (56 ± 13 vs 64 ± 21 (ml/beat) p<0.04) compared to C at rest. The decreased MO2P in the BAV group approached significance (6.6 ± 1.7 vs 7.6± 1.6 ml/beat P=0.06) compared to C. In BAV, %PO2P was significantly decrease (94 ± 24 vs 113 ± 18 (%) p<0.01). Max RER was not significantly different in BAV and C groups (1.19 ± 0.08 vs 1.19 ± 0.06). MO2P significantly correlated to cardiac output (r=0.67 p<0.05). Significance was set at p< 0.05. CONCLUSION: BAV and C groups reached the same intensity of exercise as reflected by the RER. The BAV group had decreased systolic blood pressure and O2Pulse response to exercise. These data suggest that in the face of a mild aortic valve gradient and normal shortening fraction, these BAV patients had a diminished hemodynamic response to exercise.

Conditioned Pain Modulation And Blood Pressure Responses To Cold Pressor Test Among Resistance Exercisers

Conditioned pain modulation (CPM) examines central pain inhibitory processing by assessing changes of sensitivity to the first pain stimulus after exposure to the second pain stimulus compared to baseline, and serves as risk factor of chronic pain. Aerobically-trained individuals typically show greater CPM compared to controls, but little is known regarding CPM among resistance exercisers (REs) who habitually engage in resistance exercise/strength training. REs often show elevated resting blood pressure (BP), which is associated with greater BP responses to cold pressor test (CPT) of immersing a hand into a cold water bath. Given past research showing the positive association between CPM and BP responses to CPT as the second pain stimulus, REs may exhibit greater CPM, along with augmented BP responses to CPT. PURPOSE: To compare CPM and BP responses to CPT between REs and controls. METHODS: REs were primarily recruited from weight lifting and power lifting teams (n = 15). Controls were healthy, normally active individuals (NAs) (n = 15). The participants completed the CPM test to evaluate changes in pain ratings (0-100) to electrical stimuli delivered to the ankle after CPT for a maximum of 2 minutes compared to baseline. The magnitude of CPM was calculated as change scores: post-CPT pain ratings - baseline pain ratings, with smaller pain ratings indicating greater pain inhibition. BP was assessed at baseline and every minute during CPT. CPM and BP data were analyzed using a mixed model ANOVA. The relationship between CPM and BP was tested using a correlational analysis. RESULTS: Each group consisted of young, 9 men and 6 women (REs: 23 ± 5 yrs vs. NAs: 22 ± 2 yrs, p > 0.05). REs reported spending 9.1 ± 4.5 hours/week for resistance exercise. REs and NAs exhibited comparable CPM (Change scores. REs: -12 ± 12 vs. NAs: -14 ± 12, p > 0.05), but REs showed greater systolic BP responses to CPT compared to NAs (Mean SBP. REs: 129 ± 11 mmHg vs. NAs: 119 ± 14 mmHg, p < 0.05). No significant association was found between systolic BP and CPM in REs (Resting: r = 0.2, p > 0.05 & Reactivity: r = -0.2, p > 0.05), but resting systolic BP was positively associated with CPM in NAs (Resting: r = 0.5, p < 0.05 & Reactivity: r = -0.1, p > 0.05). CONCLUSION: The role of BP in CPM is likely complex, and the potential role of exercise in central pain processing needs to be studied.

Test-Reliability Of Blood Pressure Criteria For Defining An Exaggerated Blood Pressure Response To Exercise

Exaggerated blood pressure responses (EBPR) during exercise are associated with increased risk of mortality. Due to the prognostic value of EBPR, it is important to evaluate the reliability of criteria used to define this response. PURPOSE: This study assessed the test-retest reliability of two different criteria used to define EBPR: the maximal systolic blood pressure (SBP) and the SBP/METs-slope which is the ratio of the change in SBP to the change in the metabolic equivalents of task (METs). METHODS: Twenty healthy, normotensive adults (8 males: 21±1 years, 12 females: 21±1 years) completed two identical modified Bruce treadmill tests on separate days. Blood pressure was measured using an automated motion-tolerant auscultatory device at rest (i.e., standing on treadmill) and during the last minute of each exercise stage. For each test, maximal SBP was identified, METs were estimated, and the change in these indices (i.e., maximal – rest) were calculated to determine the SBP/METs-slope. Test-retest reliability of the two criteria were assessed using intraclass correlation coefficients (ICC), with an ICC > 0.60 considered reliable. RESULTS: Total exercise time was similar between visits (1000±123 s vs. 1005±128 s, P=0.33). Reliability of the EBPR criteria are presented as (ICC; 95% confident intervals). Maximal SBP (0.45; 0.02-0.74) and SBP/METs-slope (0.29; -0.16-0.64) were not reliable. Participants were then separated based on sex. In males, maximal SBP (0.85; 0.44-0.97) was reliable while the SBP/METs-slope only demonstrated moderate reliability (0.59; -0.13-0.90). In females, both maximal SBP and the SBP/METs-slope were not reliable (ICCs <0.17). Using the criteria of a maximal SBP ≥210 and ≥190 mmHg for males and females respectively, 50% of males and 33% of females had EBPR on both visits. CONCLUSION: Criteria used to define EBPR are only reliable in males. Further investigation is warranted to understand the potential sex effects on the SBP responses to maximal exercise testing.

Baseline Cardiac Autonomic Predictors Of Blood Pressure Response To Standardized Endurance Training In Hypertensive Women

Although international recommendations corroborate the antihypertensive effects of regular endurance training (ET), interindividual responses are widely heterogeneous, differing between responders (RE) and non-responders (NR). Previous studies have shown the decrease in the activity of the autonomic nervous system (ANS) is involved in the ET-induced reduction of blood pressure (BP). However, it is not yet known whether this mechanism is related to the variability of BP response. PURPOSE: Associate baseline ANS variables with interindividual BP responses in hypertensive women undergoing ET. METHODS: Forty-four women performed 12 weeks of ET on cycle ergometer (50 min.day-1, 3 days.week-1 at 60-70% heart rate reserve). Pre and post ET 20 min beat-to-beat BP waveforms were recorded by finger photoplethysmography and ANS was assessed by heart rate (HR) variability (HRV) recorded from HR monitor and analyzed in the time and frequency domain. Participants were identified as RE by a magnitude of reduction in systolic BP (SBP) greater than the typical error (TE) of measurement (1xTE=7.4 mmHg) and participants with changes less or increase greater than 1xTE as NR. Associations between baseline HRV variables and changes (Δ) in BP after ET were analyzed using Pearson’s correlation coefficient and multiple linear regression. Student's t-test to comparisons RE vs. NR. Receiver operator characteristic (ROC) curve to identify predictors cut-off values for RE and NR discrimination. RESULTS: Ten individuals were considered RE (Δ=-15.6±7.6 mmHg) and 34 NR (Δ=4.3±7.9 mmHg). SBP changes were correlated with: SDNN (r=0.395; p=0.008), RMSSD (r=0.384; p=0.010), LF (r=0.318; p=0.036) and HF (r=0.348; p=0.02). SDNN was able to predict 15.6% of variance in SBP changes (β=0.39, p=0.008). Compared to RE, NR demonstrated greater SDNN (29.6±21.4 vs. 16.1±4.9, p=0.09), RMSSD (32.7±27.3 vs. 17.4±8.6, p=0.013) and LF (591±1380 vs. 110±71, p=0.001) and HF (668±1340 vs. 154±164, p=0.012). For SDNN, a cut-off value of 18.7 discriminated RE and NR with good accuracy (AUC=0.81, sensitivity=80%, specificity=76%, p=0.03). CONCLUSION: Baseline cardiac autonomic function can predict interindividual SBP responses to ET. Predictors cut-off values could be used to determine whether patients with hypertension are likely to benefit from ET.

The HDAC Inhibitor Emodin Blocks Hypertension-Induced Cardiac Hypertrophy: A Mediating Role for the Gut?

Abstract Objectives Evidence suggests that food bioactives impact the epigenome to prevent pathological cardiac hypertrophy. Recently, we showed that emodin, an anthraquinone, attenuated pathological cardiac hypertrophy and histone deacetylase (HDAC) activity. However, we only examined the cardioprotective effects of emodin's parent compound, not of emodin metabolites or of emodin-gut microbiome interactions. The microbiome has emerged as a key player in chronic diseases such as metabolic and cardiac disease. Thus, we hypothesized that emodin could reverse hypertension-induced changes in microbial communities. Methods Normo- and hypertensive (angiotensin ii) C57/BL6 female mice were randomly assigned to receive vehicle (Veh, DMSO: PEG 1:1) or emodin (Emod, 30 mg/kg) for 14 days. Body weight was collected pre- and post-treatment and blood pressure assessed via tail-cuff. At study end, mice were euthanized and assessed for heart weight and fibrosis. In addition, stool samples and cecal content were collected to elucidate changes in microbial populations using 16S rRNA sequencing. Lastly, tissue was lysed and RNA isolated for RNA sequencing. One-way ANOVA with Tukey's post-hoc was performed unless otherwise specified and P &amp;lt; 0.05 considered significant. Results Emodin significantly attenuated cardiac hypertrophy and fibrosis in female mice. No significant changes were observed for body weight or systolic blood pressure in response to hypertension or emodin. Lastly, preliminary analysis suggests that hypertension altered the microbiome, with evidence to support that emodin effects gut microbiota. Conclusions Our data demonstrates that emodin attenuates pathological hypertrophy and fibrosis in female mice. Whether this attenuation in cardiac remodeling is driven, in part, by the actions of emodin on the gut the microbiome remains unclear and is currently an active topic of investigation in our lab. Funding Sources This work is supported by the USDA NIFA (Hatch-NEV00767), the Dennis Meiss &amp; Janet Ralston Fund for Nutri-epigenetic Research, the National Institute for General Medical Sciences (NIGMS) of the NIH (P20 GM130459) and the National Heart, Lung, and Blood Institute of the NIH (R15 HL143496) to B.S.F. Core facilities used for Research were supported by NIGMS of the NIH (P20 GM103554).

Impact of a Supplementation with Polyphenol Extract and L-citrulline on Ambulatory Blood Pressure in Pre-Hypertensive Individuals

Abstract Objectives To investigate the short-term impact of supplementation with a combination of polyphenols extracts and L-citrulline on ambulatory blood pressure (BP), vascular function and inflammation in pre-hypertensive individuals. Methods In a randomized double-blind parallel trial, men and women with pre-hypertension were subjected to 6-wk supplementation with 764 mg/day of polyphenols extracts from cranberries and grape seeds and 2 g/day of L-citrulline (n = 35) or with placebo (cellulose, n = 34). The primary outcome of this study was the change in 24-hour ambulatory BP, which was monitored every 20 minutes during daytime and every 60 minutes during nighttime both at baseline and at week 6 post-intervention. Secondary outcomes included glycation products, a proxy of vascular function measured by a sensitive cutaneous optical method as well as blood lipids and CRP. Changes in study outcomes were analyzed using mixed models in SAS. The potential impact of sex and obesity status on the response to supplementation was also considered in the analysis. Results Supplementation with the polyphenol extracts and L-citrulline had no impact on mean ambulatory systolic (P &amp;gt; 0.10) and diastolic (P &amp;gt; 0.50) BP. However, the ambulatory systolic BP response was different in men and women (Pinteraction &amp;lt; 0.01 for 24-h BP and daytime BP) but not the diastolic BP. The ambulatory systolic BP after supplementation compared with placebo was significantly reduced in women (24-h BP −3.9 mmHg, P = 0.01; daytime BP −4.4 mmHg, P = 0.005) but not in men (24-h BP + 1.8 mmHg, P = 0.48; daytime BP + 1.8 mmHg, P = 0.55). A trend for a reduction in glycation products was observed after polyphenol and L-citrulline supplementation compared to placebo (P = 0.07) but there was no difference in the concentrations of blood lipids (P &amp;gt; 0.20 for all) or CRP (P = 0.36) between treatments. Conclusions Supplementation with polyphenol extracts/L-citrulline for 6 weeks may reduce ambulatory systolic BP in pre-hypertensive women, but not in men. The present data also indicate that the polyphenols extract/L-citrulline supplement has no impact on blood lipids and CRP in pre-hypertensive men and women. Funding Sources The study was funded by Atrium Innovations. Supplement of polyphenol extracts and L-citrulline as well as placebo were supplied by Pure Encapsulations.

Winter Pattern of Seasonality is Associated With a Blunted Systolic Blood Pressure Response to the Cold Pressor Test

Winter Pattern of Seasonality is Associated With a Blunted Systolic Blood Pressure Response to the Cold Pressor Test

Value of myocardial work for assessment of myocardial adaptation to increased afterload in patients with high blood pressure at peak exercise.

Non-invasive myocardial work (MW) indices are superior to global longitudinal strain (GLS) to assess left ventricular (LV) mechanics in situations where afterload is abnormally high. The rotational motion of the apex provides an accurate index of LV contractility. To date, there are no data about MW values during stress echocardiography (SE), particularly for the apex. Our study aims at assessing MW indices at peak exercise to better understand LV mechanics in patients with high peak systolic blood pressure (SBP). A total of 81 patients without structural or ischemic heart disease referred for SE between January and June 2019 were included. BP measurements, GLS and MW indices were performed at rest and peak exercise. In order to quantify the role of the apex, apical work fraction (AWF) was also calculated and further stratified by peak SBP. A peak SBP > 180mmHg was considered abnormally high. There were 36 (44%) patients who had peak SBP > 180mmHg. They showed similar resting GLS and MW values when compared to control. However, peak stress global work index, constructive work and wasted work (GWW) increased significantly (P-value < 0.05), with a relatively constant global work efficiency. In the multivariate analysis, peak SBP > 180mmHg was associated with threefold increased odds of abnormal peak GWW > 96.5mmHg% (median value) (odds ratio 3.0, P-value 0.003). Apical work increased significantly when stratified by peak SBP (P-value 0.003) and AWF increased from 33 ± 3% to 37 ± 3% (rest-stress), P-value < 0.0001, but remained constant when stratified by peak SBP. Our analysis provides new data on MW indices at peak stress, particularly for patients with abnormal peak SBP response, and supports the role and the contribution of the apex to MW.